If there’s one thing about Medicare plans, supplements and drug coverage options, they’re exceedingly complicated, and it’s only gotten more so over time. For nearly 30 years, Kriss Gross has been the face of Iowa SHIIP — the Senior Health Insurance Information Program — which has provided timely information to tens of thousands of Iowans to help them make informed decisions about Medicare supplement enrollment and other programs. 

As Gross prepares to retire at the end of this year, we sat down for an interview to learn about the information program that has guided retiring Iowans through the complexity for nearly three decades. 

Last year, the SHIIP program assisted about 66,000 Iowans, of which about 40,000 were helped during the open enrollment period from mid-October to early December. In 2018, SHIIP volunteers saved Iowa seniors an estimated $32 million by helping them choose the right plans. 

Iowa was among the first states to institute an information program in 1990, when the insurance commissioner at that time, Bill Hager, was told by his staff that the volume of questions seniors had about Medicare enrollment was more than the Iowa Insurance Division’s community education function could handle. 

The program was originally known as PACT, which stood for Protection and Advocacy through Community Training, Gross recalled. It was based on a peer-to-peer counseling program that Washington state had developed. 

“The idea was to train people on Medicare to help people on Medicare, to get people in the community where people could go to meet with somebody face to face,” she said. “And so we started out developing a network of local sponsor sites. And those organizations are doing it as a community service — they don’t get paid.” 

In its initial year in 1990, the program had 16 sponsor sites and about 200 volunteers. SHIIP now has 140 sponsor sites statewide, each with a site coordinator, along with about 350 volunteers who are trained to assist their neighbors within their home counties.  

In 1992, the federal government required Medicare supplement plans to provide standardized information, and SHIIP became a federally supported program available in every state and territory. With that, the program expanded to assist seniors with information related to all aspects of Medicare, not just supplement plans. The SHIIP Iowa program works with an annual budget of about $1 million, of which 80% is provided from federal funding and the remaining 20% from state funding. 

Here’s a Q&A with Gross about how the program works, and what’s ahead.

Looking back at your time with SHIIP, what has stayed the same and what’s changed?
I think the thing that’s consistent is that it’s complicated. It’s just not simple. It never was. And it’s not getting any simpler. And that when people go on Medicare, it’s different than what they’ve been used to in the workplace as far as health insurance and how it works. So there’s a lot to learn. And that hasn’t changed. 

The thing that’s different are the [number of] choices. It was pretty easy when we just had Medicare and supplements. I mean, yes, it was complicated, but your choice was finding a Medicare supplement. There was no drug coverage, and now have a choice whether they go with original Medicare or Medicare Advantage, you know, and there are many choices that change every year. And so the responsibility [for SHIIP volunteers] on behalf of people on Medicare is to stay current with these options. 

Do you advise people on Medicare to get SHIIP counseling yearly?
[Enrolling] often is confusing and complex for folks. And so that’s, you know, that’s where they come to us. And sometimes after we help them once, then they kind of get it and they’re able to do it for themselves the next year. But many people come back, because it’s just hard for them to understand it all. 

What trends are you seeing in Medicare enrollment?
A really significant change that we see is that people are delaying retirement past age 65 — they’re working well past 65. So they’re delaying their Medicare. And that brings on a whole other layer of choices and regulations that people need to understand, to make sure that they don’t have penalties for signing up at the wrong time, or that they’re not closing some doors that they don’t want to close. For the past several years, we’ve held “Welcome to Medicare” seminars so people who are approaching Medicare eligibility can learn what their options are, even if they’re not going to quit working yet. We exhibit at the Iowa State Fair every year, and 90% of the people who come to our booth are saying, “OK, I’m going to be turning 65 but I’m not going to retire. Do I have to sign up for Medicare or not?” It’s just a huge trend.

What’s the size of your staff?
There are eight people on staff right now. When we started, there was just one person [herself]. And then when the federal grant first started in ’92, we went to four staff. And so between 1992 and now, we’ve gradually added people to get to eight staff. And then we have our 350 volunteer counselors, but then we have about 140 volunteer coordinators that are at the sites. So we have almost 500 volunteers out there bringing SHIIP to the people out around the state. 

Are there an adequate number of counselors to handle demand for the program?
It’s kind of a continuous process. Because people [who volunteer with SHIIP] are retired, sometimes they want to move on to other things, sometimes there’s health issues, sometimes they want to move by their kids. So it’s a continual process of finding people who might be interested in being a SHIIP counselor. And there are some parts of the state where it’s hard to find people.  

What types of organizations are your sponsor sites?
A lot of our sponsor sites are our hospitals, which are a natural relationship because of Medicare and people trusting their local hospital. But we also have some other sites — like in Bayard, the library is our sponsor site for us. They very much see the education role that SHIIP has as part of its mission. And some UnityPoint Health clinics here in Polk County are sponsor sites for us. One of the big things with health care systems and their interest in being with SHIIP is that a lot of the initiatives in health care are to keep people healthy. Drug compliance is a big part of that; we do a lot with helping people being the right drug plans. 

What issues are coming up that your successor will be dealing with?
I think one is technology, and how we can use technology to reach people and help people. I don’t know what the term will be in the future, but like Skype counseling, where we can have a person sit in their home, and we have a SHIIP counselor talking to them from their home or something. Especially as new beneficiaries join Medicare who are used to using technology in their workplace and in their lives. Also, reaching people who have language barriers, and trying to reach out to people who have lived here long enough to qualify for Medicare, who maybe have a different cultural or ethnic experience than a lot of Iowans, I think that that is something where there’s room for us to grow. 

Do you plan to become a SHIIP counselor after you retire?
Possibly. I think we’ll give it a little break for a while, but certainly I don’t want to lose everything I’ve learned over the years. I believe in the program, certainly. I’m a firm believer in volunteering, even if I didn’t work with SHIIP, and the value it brings to life. Our volunteers have been good role models for giving back to the community, and that’s because they’re getting back so much.


ABOUT KRIS GROSS: 

Before joining the Iowa Insurance Division in 1990, Kris Gross worked for seven years for the Iowa State University Extension Service as a consumer and management specialist. She has a master’s degree in consumer economics from Cornell University in Ithaca, N.Y., and graduated from Iowa State University with a bachelor’s degree in home economics education. 


Online: SHIIP website 

The website for Iowa’s 

Senior Health Insurance Information Program is at https://shiip.iowa.gov/.