Accuracy of Medicare Information Provided by State Health Insurance Assistance Programs

Area of Science:

• Health Services Research
• Public Health Policy
• Health Communication

Background:

• Medicare beneficiaries face complex coverage choices, especially those dually eligible for Medicaid.
• The State Health Insurance Assistance Program (SHIP) offers crucial counseling, but its quality is under-researched.

Purpose of the Study:

• To assess the accessibility and quality of information provided by SHIP counselors.
• To characterize the accuracy and completeness of responses regarding Medicare coverage options.

Main Methods:

• A cross-sectional study involving 131 SHIP sites across the US.
• Mystery shoppers posed as newly eligible Medicare beneficiaries, conducting encounters via phone, in-person, and video conference.
• Responses were evaluated for accuracy and completeness based on standardized scripts.

Main Results:

• Only 39.9% of attempted SHIP encounters were completed, citing difficulties in reaching counselors.
• Completed encounters yielded an average of 40.0% accurate and complete answers.
• Counselors performed better on Traditional Medicare vs. Medicare Advantage comparisons (94.3% accurate) but less effectively on Dual-Eligible Special Needs Plans (44.8% mentioned).

Conclusions:

• SHIP counselors face challenges in providing complete and accurate Medicare information, with significant accessibility issues.
• Findings suggest a need for enhanced SHIP resources, training, and capacity to address growing Medicare Advantage enrollment and protect beneficiaries.
• Policy interventions should focus on improving SHIP's ability to deliver comprehensive guidance on complex Medicare options.