New Findings from Boston University in the Area of Health and Medicine Reported (Accuracy of Medicare Information Provided By State Health Insurance Assistance Programs): Health and Medicine

2025 MAY 02 (NewsRx) -- By a News Reporter-Staff News Editor at Health Policy and Law Daily -- Fresh data on Health and Medicine are presented in a new report. According to news reporting originating from Boston, Massachusetts, by NewsRx correspondents, research stated, “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.”

Funders for this research include Commonwealth Fund, Arnold Ventures.

Our news editors obtained a quote from the research from Boston University, “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. Setting, and ParticipantsIn 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. ExposureMystery shoppers followed scripts with questions about coverage decisions corresponding to general Medicare eligibility and dual eligibility for Medicare and Medicaid. Main Outcomes and MeasuresResponses were categorized as (1) accurate and complete, (2) accurate but incomplete, (3) not substantive, and (4) incorrect. This was a descriptive study without hypotheses. 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.”

According to the news editors, the research concluded: “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.”

For more information on this research see: Accuracy of Medicare Information Provided By State Health Insurance Assistance Programs. JAMA Network Open, 2025;8(4). JAMA Network Open can be contacted at: Amer Medical Assoc, 330 N Wabash Ave, Ste 39300, Chicago, IL 60611-5885, USA.

The news editors report that additional information may be obtained by contacting Melissa M. Garrido, Boston University, School of Public Health, Dept. of Health Law Policy and Management, 715 Albany St, Boston, MA 02118, United States. Additional authors for this research include Allison Dorneo, Kacey Dugan and Ilse Peterson.

The direct object identifier (DOI) for that additional information is: https://doi.org/10.1001/jamanetworkopen.2025.2834. This DOI is a link to an online electronic document that is either free or for purchase, and can be your direct source for a journal article and its citation.

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