What to Ask SHIP Before Choosing Coverage for a Possible Rehab Stay
A family worried about a possible future rehab stay may be tempted to choose a Medicare plan based on one advertised SNF copay.
That can miss network, authorization, doctors, prescriptions, out-of-pocket limits, and what happens after the rehab stay.
SHIP can help families compare Medicare choices without selling a plan.
Medicare describes State Health Insurance Assistance Programs (SHIPs) as free personalized health-insurance counseling programs that are not connected to insurance companies or health plans.
Bring the current coverage documents
Have:
- Medicare card;
- Medicare Advantage/Part D cards;
- Annual Notice of Change;
- Evidence of Coverage;
- medication list;
- preferred doctors;
- preferred hospital;
- likely rehab/nursing facilities; and
- other insurance/Medicaid information.
Avoid sharing account passwords.
Ask about SNF benefits
Questions:
- What are the SNF copays/coinsurance?
- Is prior authorization required?
- Which local SNFs are in network?
- What happens if the preferred facility is out of network?
- Are there different rules for HMO/PPO/SNP?
- What is the yearly out-of-pocket maximum?
Ask about continuity
If the person is already receiving treatment or enters rehab during a plan change:
- What continuity protections apply?
- Does authorization transfer?
- Could the clinician/facility leave the network?
- What enrollment period applies?
Ask about Original Medicare and Medigap implications
If considering a switch from Medicare Advantage to Original Medicare, ask about:
- Part D;
- Medigap eligibility/underwriting rights;
- provider choice;
- SNF cost sharing; and
- other coverage.
Do not assume Medigap can always be purchased later without restrictions.
Ask about drugs too
A plan with attractive rehab cost sharing may have a poor formulary or pharmacy network for the resident’s medications.
Compare the whole plan.
SHIP counseling worksheet
Current coverage: ____________________
Preferred SNFs: ____________________
SNF cost sharing: ____________________
Prior auth: ____________________
SNF network: ____________________
Doctors/hospital: ____________________
Drug coverage: ____________________
Out-of-pocket maximum: ____________________
Medigap issue: ____________________
Enrollment period: ____________________
SHIP counselor/date: ____________________
Frequently asked questions
Does SHIP sell Medicare plans?
Medicare says SHIPs are not connected to insurance companies or health plans.
Can SHIP tell me which plan is “best”?
Counselors can help compare options based on the beneficiary’s needs; the final choice remains the beneficiary’s.
Should we wait until a rehab crisis?
If possible, understand current coverage before an urgent discharge.
The practical goal
Use SHIP to compare the whole Medicare arrangement, not one rehab copay.
Network, authorization, prescriptions, clinicians, enrollment rights, and future costs all belong in the decision.
Related NHP guides
- Medicare Advantage vs Original Medicare for Rehab
- Changing Medicare Plans While Living in a Care Facility
Primary sources checked
*Editorial/source review: October 15, 2026. General education only. Appeal results, authorizations, hospice relatedness, plan selection, and billing disputes must be confirmed from the beneficiary’s actual notices, plan, and providers.*
