By Grace Vitaglione
NC Health News
The North Carolina Senate proposed budget released in April would cut state funds for a popular program that helps seniors make better choices for their Medicare plans.
For now, the program stands, as state lawmakers are at a standstill on budget negotiations and don’t expect to come to an agreement before the new fiscal year starts on July 1.
The Seniors’ Health Insurance Information Program, or SHIIP, has staff and volunteers who help older adults decide which Medicare plans work best for them. That can mean helping someone choose between a traditional plan or a Medicare Advantage plan when they first enroll, helping them switch plans during the annual open enrollment period and protecting older adults from Medicare scams.
If state lawmakers do cut funding to SHIIP, advocates for older adults say the impact would be “devastating.” People rely on the program for free, unbiased advice on Medicare.
SHIIP is funded with state and federal dollars. The Trump’s administration’s budget request released earlier this spring called for maintaining federal funding for the program, but it will depend on Congress to make the final budget.
The N.C. Senate’s proposed spending plan would cut the program’s yearly allotment of just under a million dollars in each of the next two fiscal years.
When asked about the proposed cut, Senate Leader Phil Berger (R-Eden) said he gave subcommittee chairs savings targets, and they had discretion over how to get there.
Sen. Jim Burgin (R-Angier), a top health care senator, said SHIIP was under the insurance section, not health care. But he said he’s talked to the N.C. Department of Insurance and the N.C. House of Representatives about revisiting items in the final budget.
“We want to make sure people have good information and they’re getting good service,” he said. “What everybody was trying to do is figure out areas to try to cut expenses, and now we’re going to go back and figure out what we really need to do.”
Impact in NC
Each state has a SHIIP program. North Carolinians can look up a local SHIIP counselor in their county and schedule a free appointment for unbiased advice on Medicare.
In North Carolina, the program counseled more than 69,000 Medicare beneficiaries in 2024 and saved them a total of $53 million, according to Jason Tyson, spokesperson for the N.C. Department of Insurance.
About $36 million of those savings were from helping beneficiaries enroll in plans that saved money and complete applications for the medication assistance program Extra Help and the Medicare Savings Programs. The rest of the savings came from recovered benefits and programs such as patient assistance from pharmaceutical manufacturers.
SHIIP staff processed more than 1,000 complaints. The program served over 8,000 Medicare beneficiaries with disabilities and more than 11,000 with incomes below 150 percent of the federal poverty level.
If state lawmakers were to cut SHIIP funds, it wouldn’t save the state any money, said Tyson. The Department of Insurance reimburses the state’s general fund with money from the Insurance Regulatory Fund, a pot of money financed by charges collected from insurance companies operating in the state.
Alicia Evans, who worked as a SHIIP volunteer in Burke County, said the program operates mostly on volunteer labor with a limited number of paid employees who keep everyone up to date with regular training.
Educating consumers
Robert Hooper, a SHIIP volunteer with the Satie and J.E. Broyhill Caldwell Senior Center in Caldwell County, said he was surprised to hear of the proposed cut.
“I couldn’t believe it; it’s such a de minimis amount of money, and it’s not waste, fraud or abuse,” he said.
Heather Arcuri is the Western Wake Service Coordinator for Resources for Seniors, a not-for-profit agency that coordinates services for aging and disabled Wake County residents. When she heard about the proposed cut, she said it was “devastating.”
The more money that SHIIP counselors can help people save, the more money they have for necessities like food and medication, Arcuri said.
She also said Medicare can be extremely confusing.
“Without the [SHIIP] program, we would just leave a lot of less educated consumers out there,” she said.
Arcuri said many people don’t know that they must enroll in Medicare within a limited time period around when they turn 65, unless they’re still working. If someone fails to do so, they could be hit with a late fee.
Not all workplace human resources departments are well-versed enough in Medicare to educate soon-to-be retirees, which is where SHIIP comes in, she said.
When a person first becomes eligible for Medicare, they can choose between traditional Medicare coverage, where beneficiaries pay a monthly fee and the federal government processes all of their health care bills, or Medicare Advantage, a Medicare-approved plan from a private company that provides the coverage.
That can be a big decision, Arcuri said.
Once someone chooses to go with a Medicare Advantage plan, it can be hard to switch back to original Medicare. Everybody’s situation is different, so it’s important they have all the information, she said.
While people may think only about premium prices when shopping for a Medicare plan, it’s also important to consider other pros and cons, said Thuy Dancik, a SHIIP volunteer in Wake County.
A low-cost Medicare Advantage plan may work best for someone when they’re 65 and healthy, but it may look different a few years down the line when they could have more serious health concerns. Losing the SHIIP program would make “a huge impact,” Dancik said.
‘Penny wise, pound foolish idea’
Besides the initial enrollment in Medicare, SHIIP counselors say beneficiaries should always reassess their plans each year during annual enrollment. Those with original Medicare should reevaluate their Part D, or prescription drug plan, at that time.
If someone chooses a plan that doesn’t cover their medications, preferred pharmacy or preferred doctor, the financial consequences can be significant — or they may even lose access to care, Evans said.
Open enrollment runs from Oct. 15 to Dec. 7 each year. Around this time, older adults tend to receive a big uptick in mail advertising Medicare Advantage plans. Commercials for plans also flood television airwaves. Some may advertise helping beneficiaries navigate Medicare, when they’re really soliciting a particular plan, Evans said.
“They bombard them, and they all look official, so it becomes really difficult for someone to know who to call and what is accurate,” she said.
Hooper said people he’s helped have become confused by the number of television ads for different Medicare Advantage plans.
“Anything that lessens the ability for us to contact and work with people that are in need of advice and support, it’s a penny wise, pound foolish idea,” he said.
Insurance agents may also receive incentives for selling particular plans, Evans said.
Evans has seen older adults duped into switching plans. One veteran’s family only found out he had switched off his TRICARE plan when his daughter went to pick up a prescription and found out it was no longer covered.
The veteran had attended a community event and met someone there who told him he would get information about Medicare if he signed a piece of paper, Evans said. That switched him onto a new plan, and they had to file a fraud and abuse claim through Medicare to get him back on his original plan.
Low-income people who are enrolled in both Medicare and Medicaid also heavily rely on SHIIP, Dancik said, and cutting the program’s funding would hurt staff’s ability to help them.
Evans said aging services may seem easier to cut because they’re not as “trendy” as other programs, like those for children.
“When we talk about older adults, it doesn’t hit our hearts the same way,” she said.
