FY26 State Health Insurance Program (SHIP) Survey
1.
Did you know that there are insurance counselors available in your area to explain Medicare and Medicaid?
Yes
No
2.
If yes, how did you learn about the SHIP program?
Medicare
Media
Friend/ Relative
Agency
Presentation/ Health Fair
Other (please specify)
3.
What is your county of residence?
Jefferson
Oldham
Henry
Trimble
Shelby
Spencer
Bullitt
4.
What is your age?
Under 65
65 or older
5.
Is your monthly income below $1,549 (single) or $2,080 (married)
Yes
No
6.
If yes, were you aware that you could be eligible for assistance paying for your prescription drugs and insurance costs?
Yes
No
7.
Would you like someone to contact you regarding assistance in paying for prescription drug and insurance costs?
Yes
No
If yes, please give us your name and phone number:
8.
What type of insurance do you have?
Medicare
Medicaid
Private Insurance
COBRA
Tricare
VA
Other (please specify)
9.
Do you understand your insurance benefits, coverage and fees?
Yes
No
10.
If you had a question regarding your insurance, claims or bills, do you know who to contact for assistance?
Yes
No
11.
Have you spoken with any of the following agencies regarding your Medicare or Medicaid insurance this year?
Highlands Community Ministries
Jewish Family & Career Services
KIPDA
MPCAA Bullitt
MPCAA Shelby
MPCAA Spencer
TCCAA Henry
TCCAA Oldham
TCCAA Trimble
Other (please specify)
12.
What is the name of the SHIP counselor who assisted you?
13.
Please rate the following:
Strongly agree
Agree
Disagree
Strongly disagree
The SHIP counselor was polite and helpful
Strongly agree
Agree
Disagree
Strongly disagree
The SHIP counselor provided useful and appropriate information to me
Strongly agree
Agree
Disagree
Strongly disagree
I understand the information the SHIP counselor provided
Strongly agree
Agree
Disagree
Strongly disagree
The information was provided in a timely manner
Strongly agree
Agree
Disagree
Strongly disagree
The SHIP counselor provided me with enough information to make my own informed decisions
Strongly agree
Agree
Disagree
Strongly disagree
Based on my experience, I would refer others to the SHIP counselor who assisted me
Strongly agree
Agree
Disagree
Strongly disagree
Based on my experience, I would use the SHIP counselor services in the future
Strongly agree
Agree
Disagree
Strongly disagree
Current Progress,
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