SHIIP Disclosure Form

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SHIIP counselors operate under a confidentiality agreement.  Your information will not be shared or accessed outside of the purpose of a counseling session, and it will be securely stored in your SHIIP file or shredded upon your request.

SHIIP counselors are not licensed insurance agents, and they do not sell or endorse any product, plan, or company.  If you have questions about your specific plan, we encourage you to contact your insurance agent or the insurance company.

I understand that the SHIIP counselor (paid staff or volunteer) is acting in good faith to provide information about the Medicare program and about health insurance policies and benefits on a volunteer basis, and that the information shall not be construed as legal advice.

Medicare.Gov Account

SHIIP counselors use the Medicare Plan Finder tool on the Medicare.gov website to help individuals compare Medicare Part D prescription drug plans and Medicare Advantage (Part C) health plans.

The Medicare Plan Finder offers two types of plan comparisons:

  • General Comparison – A basic overview of available plans
  • Personalized Comparison – A more accurate and tailored comparison based on your current Medicare coverage, prescriptions, and pharmacy preferences

A personalized comparison requires the individual to have a Medicare.gov account.

Benefits of a Medicare.gov Account

Creating a Medicare.gov account allows you to:

  • Store your drug list for future use
  • Update your information annually
  • Compare plans more efficiently and accurately

SHIIP Assistance with Personalized Comparisons

To help you complete a personalized plan comparison, a SHIIP counselor may:

  • Use your existing Medicare.gov username and password (with your consent), or
  • Assist you in creating a new Medicare.gov account

If authorized, SHIIP can securely store your Medicare.gov username and password to assist with plan comparisons or other Medicare-related issues in future years, only at your request.

Please note: Your Medicare.gov account will only be accessed by SHIIP with your express consent. SHIIP is required to obtain, at a minimum, verbal consent each time we use your credentials or assist in account creation.

Beginning September 2025, the Centers for Medicare & Medicaid Services (CMS) will require an email address to create a new Medicare.gov account.

Note: Existing Medicare.gov account holders are not currently required to add an email address.

Authorization Statement

If necessary, I authorize SHIIP to:

  • Assist me in creating a Medicare.gov online account
  • Create an email account for me, if required to set up a Medicare.gov account
  • Access my existing Medicare.gov account to enter or update my drug list
  • Use my account to compare Medicare Part D and/or Medicare Advantage plans
  • Securely store my Medicare.gov username and password to assist with future plan comparisons, Medicare enrollment, or claims issues upon my request
I understand that my account will only be accessed with my consent and solely for the purposes listed above.
Family member, caregiver, etc. on behalf of the Medicare beneficiary