Accuracy of Medicare Information Provided by State Health Insurance Assistance Programs.

Abstract

Importance: Medicare beneficiaries, particularly those dually eligible for Medicaid, must navigate complex coverage options. The State Health Insurance Assistance Program (SHIP) provides counseling on Medicare options, but little is known about the quality of counseling sessions.

Objective: To characterize experiences connecting to SHIP counselors, and to characterize the accuracy and completeness of information provided by counselors in response to questions about Medicare coverage options.

Design, setting, and participants: In this cross-sectional study of 131 SHIP sites across the US, mystery shoppers posed as individuals newly eligible for Medicare. Shops occurred via telephone, in-person, and videoconference encounters from September 2023 to August 2024. Statistical analysis was performed from August to September 2024.

Exposure: Mystery shoppers followed scripts with questions about coverage decisions corresponding to general Medicare eligibility and dual eligibility for Medicare and Medicaid.

Main outcomes and measures: Responses were categorized as (1) accurate and complete, (2) accurate but incomplete, (3) not substantive, and (4) incorrect. This was a descriptive study without hypotheses.

Results: Shoppers attempted 306 encounters. Of these, 122 (39.9%) could not be completed, most often because shoppers did not receive return calls. Within the 184 completed shops, the mean (SD) percentage of accurate and complete answers was 40.0% (25.7%). The percentage of responses with accurate answers (whether complete or incomplete) ranged from 26.1% (when asked whether a specific clinician was in network for a specific plan) to 94.3% (when asked about differences between traditional Medicare [TM] and Medicare Advantage [MA]). Responses were unlikely to be inaccurate (mean [SD], 6.7% [5.4%]). Fewer than half of counselors (44.8% [43 of 96]) mentioned Dual-Eligible Special Needs Plans (D-SNPs) as an option for mystery shoppers posing as dual eligibles.

Conclusions and relevance: In this study of the accuracy of Medicare information provided by SHIP counselors, shoppers encountered challenges in reaching SHIP sites, indicating possible capacity constraints; responses varied in accuracy and completeness, with better performance on questions about TM vs MA comparisons, and weaker performance on questions about integrated care plans and specific MA plan details. Given recent growth in MA and federal efforts to counter deceptive marketing practices from agents or brokers-in part by directing beneficiaries to SHIPs-policymakers should consider providing SHIP with additional resources for training and capacity improvements.