Free Medicare Help: How Your State's SHIP Counselors Can Compare Plans for You

A very common Medicare mistake has nothing to do with picking the wrong plan. It is calling the first phone number you see, usually on a glossy mailer or a TV ad, and treating the person who answers as a neutral guide. Many of those callers are licensed agents who are friendly and knowledgeable. But agents are typically paid by the plans they enroll you in, and they may not show you every option in your area.

There is a free alternative many people never use. Every state has a State Health Insurance Assistance Program, or SHIP, that offers one-on-one help with Medicare at no cost. Open enrollment starts October 15, so this is the week to line up an appointment. Here is a simple timeline, plus a script you can read word for word.

What a SHIP counselor is, and is not

There are 54 SHIPs: one in every state, plus the District of Columbia, Puerto Rico, Guam and the U.S. Virgin Islands. They are federally funded through the Administration for Community Living, and there is no cost to use them. Depending on where you live, yours may go by a different name, such as HICAP or SHINE.

SHIP counselors are trained to explain how Medicare works and to help you compare plans. They do not sell insurance or push a particular plan, and they cannot be paid for enrolling you in one. That is the main difference between a SHIP counselor and an agent.

What they will not do is make the decision for you. Think of a counselor as a patient guide who helps you see your options side by side, so you can choose with confidence.

This week: get your paperwork in one pile

A counselor can do far more in one visit if you arrive prepared. Put these items in a folder or on the kitchen table:

Your red, white and blue Medicare card, or the number from your Medicare account. Your current plan's card. The yearly notice your plan mailed, if you have it. A list of every prescription you take, with the dose and how often. The names of your doctors and your pharmacy.

If you also have retiree coverage, a Medigap policy, Medicaid or a supplemental plan, bring those details too. They change the advice you will get.

Before October 20: book your appointment

To find your SHIP, go to shiphelp.org and use the Find Local Medicare Help button, or call 1-877-839-2675. Many SHIPs offer phone, video and in-person visits, and some run group sessions at libraries or senior centers.

Call early. Open enrollment runs only until December 7, and counselors often get busy as the deadline nears. A date in late October or early November leaves time to think and to ask follow-up questions.

Here is a short script for the call. "Hi, I'm on Medicare and would like a free open enrollment review with a counselor. I take about six prescriptions and want to know whether my plan still fits for next year. What is your earliest appointment, and what should I bring?" That is all you need.

At the appointment: questions worth asking

Start by explaining what matters most to you. A lower monthly bill? Keeping a specific doctor? Cheaper prescriptions? Travel coverage? A counselor can tailor the comparison once they know your priorities.

Then ask these questions, in roughly this order.

"Will my current plan still cover my drugs next year, and what will I probably pay for them over the full year?" The counselor can run your list through Medicare's official Plan Finder, which estimates yearly drug and plan costs.

"Are my doctors and my pharmacy still in the plan's network?" A change here can be more disruptive than a change in price.

"What is the worst-case cost if I get sick or end up in the hospital?" This gets you past the monthly premium to the number that really matters if something goes wrong.

"Is there anything else I should be looking into?" This is where many people learn about extra help. SHIP counselors can also help people apply for Medicare Savings Programs and Part D Extra Help, which can lower out-of-pocket costs for those who qualify.

Take notes, and ask the counselor to write down the plan names you discussed. Do not worry about understanding everything on the spot. Questions after the visit are normal.

After the appointment: decide, then check the deadline

If your current plan still fits, you generally do not need to do anything. Medicare says your coverage continues automatically if you keep it. If you decide to switch, the new plan must receive your enrollment form by December 7. The new coverage begins January 1.

If you pick a new plan, confirm it. Check your Medicare account or call the plan in early January, and make sure your cards and pharmacy are set up. Medicare says to contact the plan if changes do not show up in your account within 10 days.

If you change your mind, people in Medicare Advantage can switch plans or return to Original Medicare between January 1 and March 31. That is a backup, not a plan. Making the right choice by December 7 is easier.

What a good visit can look like

Here is a made-up example to show how it works. Say Walt has stayed with the same drug plan for six years because it was easy. He brings his yearly notice, his medication list and the name of his pharmacy to a SHIP appointment.

The counselor enters his drugs into the Plan Finder and compares his current plan with a few others side by side. Walt learns that his plan still covers what he takes, but a second plan is estimated to cost less over the year. He also learns that the cheaper plan does not include his regular pharmacy in its preferred network.

Walt does not have to decide on the spot. He goes home with notes, asks his pharmacist a question and decides that staying put is the better trade. The point is not that he changed plans. The point is that he checked, and the choice was his.

Other free help if a SHIP appointment is not available

If your local SHIP is booked, you still have options. You can call 1-800-MEDICARE (1-800-633-4227), which Medicare says is available 24 hours a day. You can also use the Plan Finder at Medicare.gov/plan-compare on your own, or have a family member help you.

Some SHIPs have volunteers who work with caregivers too. If you are helping a parent, tell the SHIP you are a caregiver. The person with Medicare will need to give permission for you to speak with Medicare on their behalf.

A word on mailers and calls

Around open enrollment, mailboxes and phones fill up with offers. Some are legitimate, and some are not. Be careful about giving out your Medicare number or Social Security number to someone who contacts you unexpectedly. If you are unsure, take the offer to your SHIP or 1-800-MEDICARE and ask them to review it with you.

Whether you end up changing plans or keeping the one you have, a free review is a smart use of an afternoon. Details and availability vary by state, so check with your local SHIP for what it offers near you.