Here is what you’ll find in this week’s newsletter!
Important links 🔗 - the best articles we found this week about the Medicare Market along with links to Jared’s recent LinkedIn posts.
Deep Dive 📚 - The SHIP Squeeze
Sponsor Snapshot 🚀 - brought to you by Spark
It’s only a 5 minute read, but it will make you 10x smarter.
Here are IMPORTANT LINKS 🔗 for the week:
Proposed bill would create Medicare exchange plan, make enhanced ACA subsidies permanent- (link)
Kean Introduces Legislation to Reduce Healthcare Costs for Seniors - (link)
Democratic senator proposes expanding Medicaid to cover children - (link)
Strengthening Original Medicare (CMS) - (link)
CMS Issues CY 2027 Medicare Physician Fee Schedule Proposed Rule - (link)
Clover Health hit with data breach - (link)
25 health systems dropping Medicare Advantage plans - (link)
Broker Incentives for Ancillary Products - July 2026 Update - (link)
Jared’s recent LinkedIn posts:
DEEP DIVE 📚
The SHIP Squeeze
Every fall, millions of Medicare beneficiaries call a State Health Insurance Assistance Program (SHIP) before they touch a Medicare Advantage or Medigap plan comparison or Part D formulary.
SHIP funding is less stable than it looks on paper. That matters because SHIPs aren't a footnote in this market, they're part of its structure.
____
What SHIPs Actually Do
SHIPs date back to the Omnibus Budget Reconciliation Act of 1990, which created federal grants to states for unbiased Medicare counseling.
Today the network runs 54 grantees, every state plus D.C., Puerto Rico, Guam, and the U.S. Virgin Islands, through roughly 2,200 local sites staffed by more than 12,500 people, often embedded inside state units on aging or state departments of insurance.
Collectively SHIPs counsel close to 2 million beneficiaries, family members, and caregivers a year, including a meaningful under-65 disability population.
Their scope hits every major decision point: original Medicare vs. MA, Part D selection, Medigap underwriting and guaranteed-issue rights, LTC insurance, and fraud identification through the affiliated Senior Medicare Patrol.
Because counselors take no commission and represent no carrier, regulators treat them as a check on the market rather than a competitor in it.
____
Why This Belongs on Your Radar
SHIPs set the bar for "informed consent" at the point of sale. When a MA or Medigap complaint escalates to a state department of insurance, one of the first questions is whether the beneficiary had access to unbiased counseling, and whether the sales process steered them away from it. SHIPs are often the benchmark regulators compare the sales process against.
SHIPs move enrollment behavior at scale. A beneficiary who calls a SHIP before AEP is more likely to compare plans on total cost and network fit rather than premium alone, and more likely to know about Medigap guaranteed-issue windows that a captive agent has no incentive to mention. That has real implications for lapse rates, complaint volume, and the competitive dynamics between Medigap and MA in a given state.
SHIPs are the fallback when marketing rules tighten. Every AEP brings scrutiny of TV lead-gen ads, TPMOs, and aggressive MA sales tactics. CMS and state regulators lean on the SHIP network, alongside 1-800-MEDICARE, as the alternative whenever they tighten marketing rules. A well-funded SHIP network makes it easier, politically and practically, for regulators to crack down harder, because there's a credible free option to point people toward.
____
The Contact Numbers Were Already Sliding
Before getting to the current funding picture, it's worth looking at where SHIP capacity has stood in prior years. SHIP funding runs through the Administration for Community Living (ACL), which took over from CMS in 2014.
ACL’s annual Reports to Congress, which are the closest thing to a year-over-year national dataset for this program, show one-on-one beneficiary contacts falling from 2.94 million in Grant Year (GY) 2017 to 1.78 million in GY2021, a 39% decline.
ACL hasn't published a Report to Congress for any year since (GY2022 through GY2025 are missing from its site).
Source: ACL SHIP Reports to Congress, GY2019 and GY2021 editions
That decline isn't a single clean story, and is likely due to:
A real capacity squeeze. The Medicare beneficiary population grew 16% from 2014 to 2021, while SHIP's federal funding stayed essentially flat over the same period.
COVID, concentrated in one year. In GY2019, 45% of contacts were in-person and 44% by phone. By GY2020, phone contacts jumped to 76% and in-person collapsed to 10%, and ACL's own report says SHIPs served fewer beneficiaries as a direct result of that forced shift.
A reporting artifact, not a real drop in service. ACL's GY2021 report describes some of the "decline" may reflect undercounting rather than fewer beneficiaries actually being helped.
Market moving around SHIP rather than through it. Only an estimated 10% of Medicare beneficiaries use SHIP services in a given year, even though roughly 30% shop for plans annually, suggesting the bulk of "shopping" already happens through brokers, carrier call centers, and CMS's own self-service tools, any of which could be quietly pulling volume away from SHIP over time.
And a peer-reviewed audit suggests the calls that do connect aren't always reliable, either. A JAMA Network Open mystery-shopper study (April 2025) had shoppers contact 131 SHIP sites in 16 states. Nearly 40% of attempted contacts went uncompleted, mostly due to unreturned calls, and among the encounters that did connect, only 40% of answers were fully accurate and complete. 94% of shoppers received some accurate information on basic Traditional Medicare vs. Advantage questions, while 26% received accurate and complete information that a specific doctor was in-network for a specific plan. Outright wrong answers were rare (under 7%), but the pattern — strong on general concepts, weak on plan-specific and dual-eligible details — points to the same training and staffing constraints as the contact-volume decline.
Source: JAMA Network Open - Accuracy of Medicare Information Provided by State Health Insurance Assistance Programs
____
The Funding Picture Is Still Unsettled
Here's the part actually moving right now. In 2025, HHS proposed a reorganization, folding ACL's functions into a new Administration for Children, Families, and Communities (ACFC), and ACL's staff was cut roughly in half, hitting leadership, budget, and regional-office capacity.
The FY2026 budget proposal held SHIP's discretionary funding flat at FY2025 levels and kept mandatory Medicare Improvements for Patients and Providers Act funding intact but left open whether the ACL staff who actually administer the grants would survive the restructuring.
As of mid-2026, Congress hasn't approved the ACFC merger — FY2027 House appropriations bills so far preserve the status quo for ACL's aging-services programs — but the agency's staffing and organizational footprint remain unsettled, and grantees are already reporting budget shortfalls and hiring freezes tied to delayed funding releases during the transition.
____
Bottom line
A stable dollar figure doesn't guarantee stable service capacity.
With the federal administrative apparatus behind SHIP grants still disrupted, call volume, appointment availability, and local staffing may all tighten heading into AEP.
That's worth tracking alongside the usual AEP marketing and enrollment coverage: a thinner SHIP network shifts more of the "who explains guaranteed issue and star ratings" burden onto agents, carriers, and the marketing rules that govern them.
Watch how the ACL reorganization resolves - it's one of the more underappreciated regulatory variables in play for 2026 and 2027.
____
Sources
Administration for Community Living (acl.gov), including SHIP Reports to Congress GY2019 and GY2021; KFF, "The Role of State Health Insurance Assistance Programs (SHIPs) in Helping People with Medicare Navigate Their Coverage;" Congressional Research Service; National Council on Aging appropriations tracker.
SPONSOR SNAPSHOT 🚀: Spark
Medicare hasn’t been this unpredictable in years. Are your agents ready?
Plans keep exiting, Medicare-only enrollments are shrinking, and in-person consults are no longer the most efficient way to support clients. The industry has shifted, and agents need a new strategy.
The AEP 2027 Agent Playbook is Spark’s definitive guide to what agents need to do differently this year:
Diversify your book to protect against plan exits. Over-reliance on a single carrier is a serious risk.
Expand beyond Medicare to support your clients and margins. Clients are increasingly receptive to ancillaries like short-term care to close coverage gaps.
Double down on client relationships with tech-enabled workflows that scale. AI can help keep client data current and flag who needs attention.
Bolster your carrier partnerships by ensuring enrollments hold up to compliance scrutiny and helping clients activate their benefits.
See how you can help your agents act on these principles to keep clients’ trust and carriers’ confidence. Grab our guide and share it with your agents and sub-agencies to help them walk into AEP with an actual plan, not just luck from last year.
Your guide to success → Download the playbook
What MMI + Subscribers read this week…
Receive regulatory updates with the Insurance Regulatory Insights newsletter.
Monthly newsletters providing insight into recent insurance regulatory action
Access to Reg Tracker, a comprehensive list of insurance regulatory actions in all states for this calendar year that are included in the newsletters.
Insurance Regulatory Insights is now included in your MMI+ subscription! You can also subscribe using the link below.
How was today's newsletter?
If you’re ready, here are some ways we can help you:
Did this get forwarded to you? Get the Medicare Market Insights newsletter sent directly to your email weekly:
