Learn About the State Health Insurance Assistance Program (SHIP) and What Services They Offer People with Medicare

As a contractor for Medicare, Acentra Health serves as the Beneficiary and Family Centered Care Quality Improvement Organization, also referred to as a BFCC-QIO. While Acentra Health provides BFCC-QIO services in 29 states (visit www.acentraqio.com to see the states served), the general information is relevant to everyone who has Medicare (including Medicare Advantage) and everyone who works with people who have Medicare. 

This episode is a conversation with our guest, Ray Walker. He is the Divisional Director for the Medicare Assistance Program at the Oklahoma Insurance Department. Mr. Walker has a Bachelor’s Degree in Communication from the University of Oklahoma and over 20 years experience working in and around the healthcare industry, primarily in the field of insurance. He has had the privilege of speaking to groups across the state and around the country on topics ranging from genetics to team building to Medicare. He currently serves on the Advisory Committee to the State Council on Aging and the SHIP Steering Committee (State Health Insurance Assistance Program). He also serves on the Steering Committee for the Aging Our Way Oklahoma Program.  

For more information about Acentra Health BFCC-QIO, please visit https://www.acentraqio.com.

KEY TOPICS 

00:23: Overview, introduction of guest, Ray Walker

01:48: What is SHIP?

05:35: When to set up Medicare

06:45: How does SHIP help people with Medicare?

07:43: What is the process for assistance?

11:00: Do they help find financial assistance?

14:40: How is SHIP staffed?

16:27: Summary and final thoughts 

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RESOURCES

BFCC-QIO Information for stakeholders: www.acentraqio.com/partners

BFCC-QIO Information for people who have Medicare: https://www.acentraqio.com/bene/helpline

SHIP Information –https://www.shiphelp.org/ 

Oklahoma Department of Insurance - https://www.oid.ok.gov/

Music: Motivational Upbeat Corporate by RinkevichMusic 

https://soundcloud.com/rinkevichmusic

https://protunes.net/

Video Link: https://bit.ly/3NNqGTs

Transcript

Welcome to Aging Health Matters, a podcast from Acentra Health, a Beneficiary and Family Centered Care Quality Improvement Organization. We plan to cover healthcare topics for the Medicare population. Information in today's show may help you or someone you know in their healthcare journey. Thanks for joining us. Now let's get started.   

Hello everyone. I'm Nancy Jobe, an Outreach Specialist for Acentra Health and welcome to Aging Health Matters. Acentra Health is the Beneficiary and Family Centered Care Quality Improvement Organization, providing services for Medicare beneficiaries in 29 states. And we have three key services for people who have Medicare. Beneficiaries have a right to appeal discharges from the hospital and skilled service terminations. Acentra Health helps beneficiaries with Immediate Advocacy to resolve medical care issues they may encounter, and beneficiaries can file a quality of care complaint. You can find more information on our website at acentraqiocom. 

We also work with many outstanding partners to help spread information about the Medicare program and its benefits. While we greatly appreciate their partnerships, we also want to be clear that the opinions and guidance expressed by them in this podcast are solely theirs or their agencies and are not necessarily, those of the QIO, CMS, or the Medicare program. Please keep in mind that state-by-state guidance may differ as well. I'm excited to say that today we will be learning about the State Health Insurance Assistance program or SHIP, and we have Ray Walker from the Oklahoma Department of Insurance as our guest. And I'm here to introduce Ray. So Ray, how can you tell us a little bit about yourself, and then we'll go into what the SHIP is.

All right. Well, thank you, Nancy so much for inviting me to do this. I didn't even know you did a podcast like this, so I am thrilled to death to be able to participate and be part of your program. What the SHIP program does is we provide counseling to Medicare beneficiaries and their family members and caregivers about what Medicare is and how Medicare works and what the different parts of Medicare are. You know there's Medicare Part A, and there's Medicare Part B. And people don't realize that there's all these different parts. Part A is what covers you when you're in the hospital or in a skilled nursing facility. And then you've got your Medicare Part B, which is your outpatient services, and then they came up with Medicare Part C, which is Medicare Advantage plans, the HMOs and the PPOs. So it's great that they've got all these different options that are available to people, but it kind of made things very confusing, so they came up with the State Health Insurance Assistance Program,
 to help educate people on the different parts of Medicare and how Medicare works. And there's a program like ours located in every state.

So we're in Oklahoma. Our program is actually called the Medicare Assistance Program or MAP. We're located at the Oklahoma Insurance Department. In other states, they may be called SHIBA or SHINE. I don't know what all the acronyms mean. Some states they're just called SHIP. And they're very easy to find. If you're looking for a program like ours, you can actually go to the website, shiphelp.org, and you can go on there and find the program like ours in every state. But we provide counseling on what Medicare is. We help people identify if they're looking for a Part D prescription drug program. We can help them figure out which drug program is going to cover all of their prescriptions at the pharmacy that they want to go to at the best cost. So we help people pick those out. We help people with Medicare supplement plans as well. We help them figure out what the cost would be for a Medicare supplement plan, and we help them explore. Maybe they don't know whether they would like to enroll in a Medicare supplement plan or Medicare Advantage plan. So we talk to them about the pros and the cons of the two options. 

Also, they may have a retiree plan that they've got through a previous employer, or they may have access to benefits through veterans or Tricare because they were in the military, and people oftentimes will wind up having too much insurance. They didn't realize that they had all these different benefits available to them, so we try to help them sort out what do they have? What's available to them? And what do they need? Do they even need to get anything else, or do they have all the insurance that they need, and they can just go on about their business and not have to worry about it? And then at the same time, unfortunately, there are challenges that come up. Sometimes people will have problems with claims, and they need to try to sort out how do they resolve those issues. Or how do they file an appeal if they're having a problem, or as you well know, Nancy, sometimes people have got a loved one that's in the hospital.
 
And they don't know where to turn for some answers, and often times we wind up referring people to Acentra and getting you involved. So we just try to act as a local resource for people who have issues or questions regarding their Medicare.

That’s a lot of information, Ray. So we're going to break it down a little bit for our audience. I know I have a little bit of a background with the SHIP program myself, so I understand exactly what all you do, and it's a lot. You were talking about all the different parts of Medicare. I would say that a person that is getting ready to be on Medicare, like turning 65, at what point should they be maybe contacting you to start setting up what's going to happen when they get on to Medicare?

That is a very good question because different people get on Medicare at different times. You know we're very used to the idea of when a person turns 65, boom, they're on Medicare. That's not necessarily the case. People nowadays are working well past the age of 65. They're working into their 70s, and they may have group health insurance while they're working. As long as you're still working and you've got group health insurance coverage, you don't have to start your Medicare. You can actually delay Medicare and start it at a later date. So we typically will tell people that probably about six months before they're going to start their Medicare coverage is a good time for them to start exploring what their coverage is going to be once they're going to actually retire and get their Medicare started.

And the point that you made there is like six months out, these same people that maybe they were going to turn 65, six months out of turning 65, they start getting inundated with all kinds of mailers. And it's very confusing, and everybody has the best thing. I advocate for the SHIP program because I think people really need to get informed decisions from an unbiased source. And that's what the SHIP program will do.

Yes.

They're going to give you the information that you really need. They're not going to gain anything out of it. They're not getting commission, or they're not getting this or that. It's set up just for them to gather information.

When the SHIP program was created, they wanted free, unbiased counseling. We don't get any money from any insurance companies or anything like that. We're not going to tell somebody what to do. We just want them to know what all of their options are, so that they can make the best decision for themselves.

Right. And I think that's the main point that people really need to understand about the SHIP program because they have so many people telling them what to do and how to do it and everything between friends, neighbors, everyone, and all the mailers and phone calls that they receive. It's a great to reach out to the SHIP program, and their state is going to be their best recourse to really gather what they personally need because everybody is different.

Absolutely. Yes.

So when they do call you and you want to assist them with that. Do you tell them the options of all of like, for instance, the Medicare supplements as opposed to Medicare Advantage plans and what the advantages are for all of that?

You know the first thing that we're going to do is if someone calls and starts asking us those questions, we need to get to know them a little bit. Again, we're going to ask you now, so are you still working? Do you have group health insurance coverage? If not, do you have Tricare, or do you have veterans benefits? Also, is someone a member of one of the American Indian tribes? Do they have access to benefits through Indian Health Services? We also want to ascertain does somebody get benefits through Medicaid or some other assistance program? So it's very important that we find out what's already there and already in place for someone.
 
There's a challenge that can arise if someone is currently receiving benefits in some area. We don't want to make a decision or help somebody make a decision that could impact negatively some coverage that they've currently got. So it's very important that we know what they have now, so that something that they enroll in doesn't mess up something that they've got already.
 
So we're going to talk to them about what they have because then we know, do they need a Medicare supplement if they've already got, let's say, Tricare, which is the coverage that's available to the people that have served in the military, then they may not really need to get a Medicare supplement because they're going to have access to what's called Tricare for Life, which acts as a Medicare supplement, and it includes drug coverage. So for them, they probably wouldn't need that. Someone who's retiring from federal service would have access to retirement benefits through the federal government. However, if you're retiring from, say, like a private company, that really doesn't offer retiree coverage, then that person might want to look at the options, a Medicare Advantage plan, which would be an HMO or a PPO or something like that versus a Medicare supplement plan, which is also called a Medigap policy, which works with your traditional Medicare. It comes in and pays after your traditional Medicare is paid. So lots of different options there, lots of different things to consider. You've got to understand how Medicare Advantage plans work.
 
You have to know what networks are available. Are the doctors that you like to see in the hospitals that you want to go to? Are they contracted with those Medicare Advantage plans? Do you live in an area that Medicare Advantage plans are working in and they've got networks that are available to you? Are you someone that likes to travel? If you're a person that likes to travel a lot and you're going to be out of the service area for a Medicare Advantage plan, perhaps that's not going to be the best option for you.
 
So again it's getting to know the person, how the person plans to live, what their plans are in terms of traveling and things like that. Those are going to be important things for that person to consider and knowing what their options are moving forward. 

And a point that you brought up was as you're getting to know these people too, you're also finding out what kind of a budget they have to work with because nothing's free. So, I mean, you're having to pay for these things. Do you help people with finding some, like financial assistance with some of the things?

Yes, we do. Often times seniors are on a very fixed budget, sometimes a very limited income, and there are assistance programs out there. We're all familiar with the term Medicaid, and we know that that's for people who are on a seriously low income. But the good news is there are some other programs that are available that may not provide as much assistance as the Medicaid program does, but that are available to people who may have a higher level of income that will pay part of those costs. So there are some programs that will pay perhaps maybe the Part B monthly premium. This year, as you know, the Part B monthly premium is $185 a month.

So if there's a program that would pay that Part B monthly premium, that can really help somebody out. So if they meet the income and asset limits for that program, we can help them get signed up for that program. Also, there's a program called Extra Help. That if a person meets the income and asset limits for that program, it'll pay the monthly premium for their Part D prescription drug plan. And it will also lower the co-pays for their prescription medications. So we try to help someone get qualified for some of these other assistance programs, and then we can also point them to other ways that they can save money on their healthcare costs and try to make the most of that fixed income that they find themselves on now that they're in their retirement years.

So there's a lot of information that people have to gather to make an informed decision and by contacting the SHIP programs, they're going to be able to at least have the best information it sounds like. 
 
Absolutely, absolutely. And it's not a one-time phone call. We've got clients that we speak to probably on an annual basis because, for example, when you're picking out your Part D prescription drug plan, that's not something that you do one time, you're actually going to want to review your drug coverage every single year because those drug plans change, the cost of the plans, the monthly premiums. the co-pays for the medications. Also, the medications that we as individuals take can change on a constant basis, so people can save an awful lot of money just by reviewing their Part D plan every single year. Last year, during the Open Enrollment period, we saved the people that contacted us an average of over $3,000 for 2025 per person. It can save you a whole lot of money just by making sure you're on the best plan that's going to give you the best cost for the coming year.

That's a great point too because people do need to check during Open Enrollment between October and December. And we're going to actually have a podcast about that in September. So if you're listening, be sure and check for the September podcast because we're really going to depth about what Open Enrollment is and how to get help with that. It's a really important step. Everybody should check that because those health plans change every year.

And they're different in every state, so not every state's going to have the same Part D prescription drug plans. Not every state is going to have the same Medicare Advantage plans. It's very individualized, so you may have a sister that's on one plan in Missouri, but that doesn't mean it’s going to work as well in New Mexico. So definitely reach out to your SHIP program.

That's good advice. Let me just do one more question too because you've given all this advice and everything, and I have to ask this. Are you staffed with paid staff? Do you have volunteers as counselors? How does your program work? Because I know every state's a little different. I worked with the state, and we had a lot of volunteers. So if somebody was interested in helping, they could.

Yes, absolutely. We have got both paid staff as well as volunteers. Also here in Oklahoma, we have contracts with several agencies around the state. So several of the Area Agencies on Aging here in Oklahoma are contracted with our program. Also, Opportunities Incorporated, one of the Community Action agencies here in Oklahoma, is contracted with us as well as Life Senior Services in the Tulsa market is one of our contracted partners. So all of those entities also provide the same counseling that we provide here in the Oklahoma City office. Each one of those entities has their own volunteers that they work with that provide our volunteers. Some of them do counseling. Some of them may just work at a booth. Some of them may just disseminate brochures. It's just kind of whatever a volunteer feels comfortable doing. But they can certainly be such an asset to a program such as ours.

Some of our listeners could, if they're interested in trying in trying to volunteer for some organization, can they find that information through the shiphelp?

They could. Or if they're interested, you know, ship help.org is a great place to find out from each individual state here in Oklahoma, or they can call us at 1-800-763-2828. They're perfectly welcome to call that number, and we'll help them get connected to whatever state they want to.

That's great because I know there's a lot of retirees out there that are very knowledgeable and would be a great asset to these programs.

Do you have anything else that you'd like to close out for us today as far as some tips or some pieces of wisdom?

Yes. The main thing is it would be wonderful if we could all just retire and not have to think about our Medicare after we retire. But unfortunately, that isn't the case. It's something that is constantly changing and evolving. So, I strongly encourage all Medicare beneficiaries to stay focused and to pay attention to their benefits, to be vigilant, to always look at your Medicare Summary Notices. Make sure that you're aware of what's been charged to your Medicare number. Look for things that have been denied. Not all the time is everything going to be approved. So if you see something that's denied, keep in mind folks, you don't have to accept that denial. You got up to five levels of appeals. Know what your benefits are. Be aware that Medicare covers many, many preventive services and take advantage of those preventive services. Be in touch with your primary care doctor. Stay healthy.

Good point. Ray, I really do appreciate you giving us some time today because you had so much great knowledge that we were able to share with our listeners. And as a listener, if you have any need for finding out more information about any of the Medicare pieces that you may have, please reach out to your state SHIP program, and you can do that through shiphelp.org to find how to contact the SHIP in your state. I want to thank you again, Ray, for being a great guest for us today and giving us so much information.

Well, thank you.

And check out in our Show Notes for more information about today's podcast, and we want to thank you for listening to Aging Health Matters. Go to our website at acentraqio.com and check out our other podcast topics or sign up for our newsletter for the most up-to-date information.