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Pagers and walkie-talkies over cellphones – a security expert explains why Hezbollah went low-tech for communications

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theconversation.com – Richard Forno, Principal Lecturer in Computer Science and Electrical Engineering, of Maryland, Baltimore County – 2024-09-18 16:32:21

A police officer examines a damaged car after thousands of pagers exploded simultaneously across Lebanon on Sept. 17, 2024.
AP Photo/Hussein Malla

Richard Forno, University of Maryland, Baltimore County

Electronic pagers across Lebanon exploded simultaneously on Sept. 17, 2024, killing 12 and wounding more than 2,700. The following day, another wave of explosions in the country came from detonating walkie-talkies. The attacks appeared to target members of the militant group Hezbollah.

The pagers attack involved explosives planted in the communications devices by Israeli operatives, according to U.S. officials cited by The New York Times. Hezbollah had recently ordered a shipment of pagers, according to the report.

Secretly attacking the supply chain is not a new technique in intelligence and military operations. For example, the U.S. National Security Agency intercepted computer hardware bound for overseas customers, inserted malware or other surveillance tools and then repackaged them for delivery to certain foreign buyers, a 2010 NSA internal document showed. This differs from accessing a specific person’s device, such as when Israel’s Shin Bet secretly inserted explosives into a cellphone to remotely kill a Hamas bombmaker in 1996.

Hezbollah, a longtime adversary of Israel, had increased its use of pagers in the wake of the Hamas attack on Israel on Oct. 7, 2023. By shifting to relatively low-tech communication devices, pagers and walkie-talkies, Hezbollah apparently sought an advantage against Israel’s well-known sophistication in tracking targets through their phones.

Pagers and walkie-talkies over cellphones – a security expert explains why Hezbollah went low-tech for communications
The second wave of explosions in Lebanon involved walkie-talkies.
AP Photo

Cellphones: The ultimate tracker

As a former cybersecurity professional and current security researcher, I view cellular devices as the ultimate tracking tool for both and commercial entities – in addition to users, criminals and the mobile phone provider itself. As a result, mobile phone tracking has contributed to the fight against terrorism, located missing people and helped solve crimes.

Conversely, mobile phone tracking makes it easy for anyone to record a person’s most intimate movements. This can be done for legitimate purposes such as parents tracking ‘s movements, helping you find your car in a parking lot, and commercial advertising, or nefarious ends such as remotely spying on a lover suspected of cheating or tracking political activists and journalists. Even the U.S. military remains concerned with how its soldiers might be tracked by their phones.

Mobile device tracking is conducted in several ways. First, there is the network location data generated by the phone as it moves past local cell towers or Stingray devices, which law enforcement agencies use to mimic cell towers. Then there are the features built into the phone’s operating system or enabled by downloaded apps that may lead to highly detailed user tracking, which users unwittingly agree to by ignoring the software’s privacy policy or terms of service.

This collected data is sometimes sold to governments or other companies for additional data mining and user profiling. And modern smartphones also have built-in Bluetooth, Wi-Fi and GPS capabilities that can help with locating and tracking user movements around the world, both from the ground and via satellites.

Your phone contains many sensors that make it useful – and easy to track.

Mobile devices can be tracked in real time or close to it. Common technical methods include traditional radio direction-finding techniques, using intelligence satellites or drones, deploying “man in the middle” tools like Stingrays to impersonate cellular towers to intercept and isolate device traffic, or installing malware such as Pegasus, made by Israeli cyberarms company NSO to report a device’s location.

Nontechnical and slower techniques of user tracking include potentially identifying general user locations from their internet activity. This can be done from website logs or the metadata contained in content posted to social , or contracting with data brokers to any collected location data from the apps that a user might install on their device.

Indeed, because of these vulnerabilities, the leader of Hezbollah earlier this year advised his members to avoid using cellular phones in their activities, noting that Israel’s “surveillance devices are in your pockets. If you are looking for the Israeli agent, look at the phone in your hands and those of your wives and children.”

Researchers have shown how these features, often intended for the user’s convenience, can be used by governments, companies and criminals to track people in their lives and even predict movements. Many people still aren’t aware of how much their mobile devices disclose about them.

Pagers, however, unlike mobile phones, can be harder to track depending on whether they support two-way communication.

Why go low-tech

A pager that only receives messages does not a signal that can facilitate tracking its owner. Therefore, Hezbollah’s use of pagers likely made it more challenging to track their operatives – thus motivating Israeli intelligence services’ purported attack on the supply chain of Hezbollah’s pagers.

Using low-tech tactics and personal couriers while avoiding the use of mobile phones and digital tools also made it difficult for the technologically superior Western intelligence agencies to locate Osama bin Laden for years after the 9/11 attacks.

In general, I believe the adversary in an asymmetric conflict using low-tech techniques, tactics and technology will almost always be able to operate successfully against a more powerful and well-funded opponent.

A well-documented demonstration of this asymmetry in action was the U.S. military’s Millennium Challenge war game in 2002. Among other things, the insurgent Red forces, led by Marine General Paul van Riper, used low-tech tactics including motorcycle couriers instead of cellphones to evade the Blue forces’ high-tech surveillance. In the initial of the exercise, the Red team won the contest in 24 hours, forcing exercise planners to controversially reset and update the scenario to ensure a Blue team victory.

Lessons for everyone

The preference for terrorist organizations like Hezbollah and al-Qaida to avoid using smartphones is a reminder for everyone that you can be, and likely are being tracked in various ways and for various purposes.

Israel’s purported response to Hezbollah’s actions also a lesson for everyone. From a cybersecurity perspective, it shows that any device in your life can be tampered with by an adversary at points along the supply chain – long before you even receive it.The Conversation

Richard Forno, Principal Lecturer in Computer Science and Electrical Engineering, University of Maryland, Baltimore County

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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Comet Tsuchinshan-ATLAS is a Halloween visitor from the spooky Oort Cloud − the invisible bubble that’s home to countless space objects

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theconversation.com – James Wray, Professor of Earth and Atmospheric Sciences, Georgia Institute of Technology – 2024-10-11 12:36:00

The human mind may find it difficult to conceptualize: a cosmic cloud so colossal it surrounds the Sun and eight planets as it extends trillions of miles into deep space.

The spherical shell known as the Oort Cloud is, for all practical purposes, invisible. Its constituent particles are spread so thinly, and so far from the light of any star, including the Sun, that astronomers simply cannot see the cloud, even though it envelops us like a blanket.

It is also theoretical. Astronomers infer the Oort Cloud is there because it’s the only logical explanation for the arrival of a certain class of comets that sporadically visit our solar system. The cloud, it turns out, is basically a gigantic reservoir that may hold billions of icy celestial bodies.

Two of those bodies will pass by Earth in the days leading up to Halloween. Tsuchinshan-ATLAS, also known as Comet C/2023 A3, will be at its brightest, and likely visible to the naked eye, for a or two after Oct. 12, the day it’s closest to Earth – just look to the western sky shortly after sunset. As the days pass, the comet will get fainter and move to a higher part of the sky.

A view of comet Tsuchinshan-ATLAS from the International Space Station.

The second comet, C/2024 S1 (ATLAS), just discovered on Sept. 27, should be visible around the end of October. The comet will pass closest to Earth on Oct. 24 – look low in the eastern sky just before sunrise. Then, after swinging around the Sun, the comet may reappear in the western night sky right around Halloween. It’s possible, however, that it could disintegrate, in part or in whole, as sometimes happens when comets pass by the Sun – and this one will within 1 million miles (1.6 million kilometers) of our star.

As a planetary astronomer, I’m particularly curious about the Oort Cloud and the icy bodies inhabiting it. The Cloud’s residents may be a reason why ignited on Earth; crashing on our planet eons ago, these ice bodies may have supplied at least some of the water that all life requires. At the same time, these same objects pose an ever-present threat to Earth’s continuation – and our survival.

Billions of comets

If an Oort Cloud object finds its way to the inner solar system, its ices vaporize. That produces a tail of debris that becomes visible as a comet.

Some of these bodies, known as long-period comets, have orbits of hundreds, thousands or even millions of years, like Tsuchinshan-ATLAS. This is unlike the so-called short-period comets, which do not visit the Oort Cloud and have comparatively quick orbits. Halley’s comet, which cuts a path through the solar system and orbits the Sun every 76 years or so, is one of them.

The 20th-century Dutch astronomer Jan Oort, intrigued by the long-period comets, wrote a paper on them in 1950. He noted about 20 of the comets had an average distance from the Sun that was more than 10,000 astronomical units. This was astounding; just one AU is the distance of the Earth from the Sun, which is about 93 million miles. Multiply 93 million by 10,000, and you’ll find these comets come from over a trillion miles away. What’s more, Oort suggested, they were not necessarily the cloud’s outermost objects.

Nearly 75 years after Oort’s paper, astronomers still can’t directly image this part of space. But they do estimate the Oort Cloud spans up to 10 trillion miles from the Sun, which is almost halfway to Proxima Centauri, the next closest star.

The long-period comets spend most of their time at those vast distances, making only brief and rapid visits close to the Sun as they come in from all directions. Oort speculated the cloud contained 100 of these icy objects. That may be as numerous as the number of stars in our galaxy.

How did they get there? Oort suggested, and modern simulations have confirmed, that these icy bodies could have initially formed near Jupiter, the solar system’s largest planet. Perhaps these objects had their orbits around the Sun disturbed by Jupiter – similar to how NASA spacecraft bound for destinations from Saturn to Pluto have typically swung by the giant planet to accelerate their journeys outward.

Some of these objects would have escaped the solar system permanently, becoming interstellar objects. But others would have ended up with orbits like those of the long-period comets.

An artistic illustration of the solar system and the Oort Cloud.

An illustration of the solar system and the Oort Cloud. The numbers on the graph depict AUs, or astronomical units. Note the location of Voyager 2, which will take another 30,000 years to fly out of the Cloud.
NASA

Threats to Earth

Long-period comets present a particular potential danger to Earth. Because they are so far from our Sun, their orbits are readily altered by the gravity of other . That means scientists have no idea when or where one will appear, until it does, suddenly. By then, it’s typically closer than Jupiter and moving rapidly, at tens of thousands of miles per hour. Indeed, the fictional comet that doomed Earth in the film “Don’t Look Upcame from the Oort Cloud.

New Oort Cloud comets are discovered all the time, a dozen or so per year in recent years. The odds of any of them colliding with Earth are extremely low. But it is possible. The recent of NASA’s DART mission, which altered the orbit of a small asteroid, demonstrates one plausible approach to fending off these small bodies. But that mission was developed after years of studying its target. A comet from the Oort Cloud may not offer that much time – maybe just months, weeks or even days.

Or no time at all. ‘Oumuamua, the odd little object that our solar system in 2017, was discovered not before but after its closest approach to Earth. Although ‘Oumuamua is an interstellar object, and not from the Oort Cloud, the proposition still applies; one of these objects could sneak up on us, and the Earth would be defenseless.

One way to prepare for these objects is to better understand their basic properties, including their size and composition. Toward this end, my colleagues and I work to characterize new long-period comets. The largest known one, Bernardinelli–Bernstein, discovered just three years ago, is roughly 75 miles (120 kilometers) across. Most known comets are much smaller, from one to a few miles, and some smaller ones are too faint for us to see. But newer telescopes are helping. In particular, the Rubin Observatory’s decade-long Legacy Survey of Space and Time, starting up in 2025, may double the list of known Oort Cloud comets, which now stands at about 4,500.

The unpredictability of these objects makes them a challenging target for spacecraft, but the European Space Agency is preparing a mission to do just that: Comet Interceptor. With a launch planned for 2029, the probe will park in space until a suitable target from the Oort Cloud appears. Studying one of these ancient and pristine objects could offer scientists clues about the origins of the solar system.

As for the comets now in Earth’s vicinity, it’s OK to look up. Unlike the comet in the DiCaprio , these two will not crash into the Earth. The nearest Tsuchinshan-ATLAS will get to us is about 44 million miles (70 million kilometers); C/2024 S1 (ATLAS), about 80 million miles (130 million kilometers). Sounds like a long way, but in space, that’s a near miss.

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Happiness class is helping clinically depressed school teachers become emotionally healthy − with a cheery assist from Aristotle

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theconversation.com – John Sommers-Flanagan, Clinical Psychologist and Professor of Counseling, of Montana – 2024-10-11 07:32:00

Text saying: Uncommon Courses, from The Conversation

Uncommon Courses is an occasional series from The Conversation U.S. highlighting unconventional approaches to teaching.

Title of Course

Evidence-Based Happiness for Teachers

What prompted the idea for the course?

I was discouraged. For nearly three decades, as a clinical psychologist, I trained mental professionals on suicide assessment. The work was good but difficult.

All the while, I watched in dismay as U.S. suicide rates relentlessly increased for 20 consecutive years, from 1999 to 2018, followed by a slight dip during the COVID-19 pandemic, and then a rise in 2021 and 2022 – this despite more local, state and national suicide prevention programming than ever.

I consulted my wife, Rita, who also happens to be my favorite clinical psychologist. We decided to explore the science of happiness. Together, we established the Montana Happiness Project and began offering evidence-based happiness workshops to complement our suicide prevention work.

In 2021, the Arthur M. Blank Family Foundation, through the University of Montana, awarded us a US$150,000 grant to the state’s K-12 public school teachers, counselors and staff. We’re using the funds to offer these educators low-cost, online graduate courses on happiness. In spring 2023, the foundation awarded us another $150,000 so we could extend the program through December 2025.

What does the course explore?

Using the word “happiness” can be off-putting. Sometimes, people associate happiness with recommendations to just smile, cheer up and suppress negative emotions – which can lead to toxic positivity.

As mental health professionals, my wife and I reject that definition. Instead, we embrace Aristotle’s concept of “eudaimonic happiness”: the daily pursuit of meaning, mutually supportive relationships and becoming the best possible version of yourself.

The heart of the course is an academic, personal and experiential exploration of evidence-based positive psychology interventions. These are intentional practices that can improve mood, optimism, relationships and physical wellness and offer a sense of purpose. Examples include gratitude, acts of kindness, savoring, mindfulness, mood music, practicing forgiveness and journaling about your best possible future self.

Students are required to implement at least 10 of 14 positive psychology interventions, and then to and write about their experiences on implementing them.

Why is this course relevant now?

Teachers are more distressed than ever before. They’re anxious, depressed and discouraged in ways that adversely affect their ability to teach effectively, which is one reason why so many of them leave the profession after a short period of time. It’s not just the low pay – educators need support, appreciation and coping tools; they also need to know they’re not alone.

This exercise helps you focus on what goes right, rather than the things that go wrong.

What’s a critical lesson from the course?

The lesson on sleep is especially powerful for educators. A review of 33 studies from 15 countries reported that 36% to 61% of K-12 teachers suffered from insomnia. Although the rates varied across studies, sleep problems were generally worse when teachers were exposed to classroom violence, had low job satisfaction and were experiencing depressive symptoms.

The sleep lesson includes, along with sleep hygiene strategies, a happiness practice and insomnia intervention called Three Good Things, developed by the renowned positive psychologist Martin Seligman.

I describe the technique, in Seligman’s words: “Write down, for one week, before you go to sleep, three things that went well for you during the day, and then reflect on why they went well.”

Next, I make light of the concept: “I’ve always thought Three Good Things was hokey, simplistic and silly.” I show a of Seligman saying, “I don’t need to recommend beyond a week, typically … because when you do this, you find you like it so much, most people just keep doing it.” At that point, I roll my eyes and say, “Maybe.”

Then I share that I often awakened for years at 4 a.m. with terribly dark thoughts. Then – funny thing – I tried using Three Good Things in the middle of the night. It wasn’t a perfect solution, but it was a vast improvement over lying helplessly in bed while negative thoughts pummeled me.

The Three Good Things lesson is emblematic of how we encourage teachers in our course – using science, playful cynicism and an open and experimental mindset to apply the evidence-based happiness practices in ways that work for them.

I also encourage students to understand that the strategies I offer are not universally effective. What works for others may not work for them, which is why they should experiment with many different approaches.

What will the course prepare students to do?

The educators the course with a written lesson plan they can implement at their school, if they wish. As they deepen their happiness practice, they can also share it with other teachers, their students and their families.

Over the past 16 months, we’ve taught this course to 156 K-12 educators and other school personnel. In a not-yet-published survey that we carried out, more than 30% of the participants scored as clinically depressed prior to starting the class, with just under 13% immediately after the class.

This improvement is similar to the results obtained by antidepressant medications and psychotherapy.

The educators also reported overall better health after taking the class. Along with improved sleep, they took fewer sick days, experienced fewer headaches and reported reductions in cold, flu and stomach symptoms.

As resources allow, we plan to tailor these courses to other people with high-stress jobs. Already, we are receiving requests from police , providers, veterinarians and construction workers.

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sales pitches are often from biased sources, the choices can be overwhelming and impartial help is not equally available to all

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theconversation.com – Grace McCormack, Postdoctoral researcher of Health Policy and Economics, University of Southern California – 2024-10-10 07:32:00

It can take a lot of effort to understand the many different Medicare choices.

Halfpoint Images/Moment via Getty Images

Grace McCormack, University of Southern California and Melissa Garrido, Boston University

The 67 million Americans eligible for Medicare make an important every October: Should they make changes in their Medicare health insurance plans for the next calendar year?

The decision is complicated. Medicare has an enormous variety of coverage options, with large and varying implications for people’s health and finances, both as beneficiaries and taxpayers. And the decision is consequential – some choices lock beneficiaries out of traditional Medicare.

Beneficiaries choose an insurance plan when they turn 65 or become eligible based on qualifying chronic conditions or disabilities. After the initial sign-up, most beneficiaries can make changes only during the open enrollment period each fall.

The 2024 open enrollment period, which runs from Oct. 15 to Dec. 7, marks an to reassess options. Given the complicated nature of Medicare and the scarcity of unbiased advisers, however, finding reliable information and understanding the options available can be challenging.

We are health care policy experts who study Medicare, and even we find it complicated. One of us recently helped a relative enroll in Medicare for the first time. She’s healthy, has access to health insurance through her employer and doesn’t regularly take prescription drugs. Even in this straightforward scenario, the number of choices were overwhelming.

The stakes of these choices are even higher for people managing multiple chronic conditions. There is help available for beneficiaries, but we have found that there is considerable room for improvement – especially in making help available for everyone who needs it.

The choice is complex, especially when you are signing up for the first time and if you are eligible for both Medicare and Medicaid. Insurers often engage in aggressive and sometimes deceptive advertising and outreach through brokers and agents. Choose unbiased resources to guide you through the process, like www.shiphelp.org. Make sure to start before your 65th birthday for initial sign-up, look out for yearly plan changes, and start well before the Dec. 7 deadline for any plan changes.

2 paths with many decisions

Within Medicare, beneficiaries have a choice between two very different programs. They can enroll in either traditional Medicare, which is administered by the government, or one of the Medicare Advantage plans offered by private insurance companies.

Within each program are dozens of further choices.

Traditional Medicare is a nationally uniform cost-sharing plan for medical services that allows people to choose their providers for most types of medical care, usually without prior authorization. Deductibles for 2024 are US$1,632 for hospital costs and $240 for outpatient and medical costs. also have to chip in starting on Day 61 for a hospital stay and Day 21 for a skilled nursing facility stay. This percentage is known as coinsurance. After the yearly deductible, Medicare pays 80% of outpatient and medical costs, leaving the person with a 20% copayment. Traditional Medicare’s basic plan, known as Part A and Part B, also has no out-of-pocket maximum.

Pen, glasses and medicare health insurance card

Traditional Medicare starts with Medicare parts A and B.

Bill Oxford/iStock via Getty Images

People enrolled in traditional Medicare can also purchase supplemental coverage from a private insurance company, known as Part D, for drugs. And they can purchase supplemental coverage, known as Medigap, to lower or eliminate their deductibles, coinsurance and copayments, cap costs for Parts A and B, and add an emergency foreign travel benefit.

Part D plans prescription drug costs for about $0 to $100 a month. People with lower incomes may get extra financial help by signing up for the Medicare program Part D Extra Help or state-sponsored pharmaceutical assistance programs.

There are 10 standardized Medigap plans, also known as Medicare supplement plans. Depending on the plan, and the person’s gender, location and smoking status, Medigap typically costs from about $30 to $400 a month when a beneficiary first enrolls in Medicare.

The Medicare Advantage program allows private insurers to bundle everything together and offers many enrollment options. Compared with traditional Medicare, Medicare Advantage plans typically offer lower out-of-pocket costs. They often bundle supplemental coverage for hearing, vision and dental, which is not part of traditional Medicare.

But Medicare Advantage plans also limit provider networks, meaning that people who are enrolled in them can see only certain providers without paying extra. In comparison to traditional Medicare, Medicare Advantage enrollees on average go to lower-quality hospitals, nursing facilities, and home health agencies but see higher-quality primary care doctors.

Medicare Advantage plans also often require prior authorization – often for important services such as stays at skilled nursing facilities, home health services and dialysis.

Choice overload

Understanding the tradeoffs between premiums, health care access and out-of-pocket health care costs can be overwhelming.

Graphic of a person flow lines pointing to text boxes on either side that have smaller arrows to more text boxes holding plan choice descriptions.

Turning 65 begins the process of taking one of two major paths, which each have a thicket of health care choices.

Rika Kanaoka/USC Schaeffer Center for Health Policy & Economics

Though options vary by county, the typical Medicare beneficiary can choose between as many as 10 Medigap plans and 21 standalone Part D plans, or an average of 43 Medicare Advantage plans. People who are eligible for both Medicare and Medicaid, or have certain chronic conditions, or are in a long-term care facility have additional types of Medicare Advantage plans known as Special Needs Plans to choose among.

Medicare Advantage plans can vary in terms of networks, benefits and use of prior authorization.

Different Medicare Advantage plans have varying and large impacts on enrollee health, including dramatic differences in mortality rates. Researchers found a 16% difference per year between the best and worst Medicare Advantage plans, meaning that for every 100 people in the worst plans who die within a year, they would expect only 84 people to die within that year if all had been enrolled in the best plans instead. They also found plans that cost more had lower mortality rates, but plans that had higher federal quality ratings – known as “star ratings” – did not necessarily have lower mortality rates.

The quality of different Medicare Advantage plans, however, can be difficult for potential enrollees to assess. The federal plan finder website lists available plans and publishes a quality rating of one to five stars for each plan. But in practice, these star ratings don’t necessarily correspond to better enrollee experiences or meaningful differences in quality.

Online provider networks can also contain errors or include providers who are no longer seeing new patients, making it hard for people to choose plans that give them access to the providers they prefer.

While many Medicare Advantage plans boast about their supplemental benefits , such as vision and dental coverage, it’s often difficult to understand how generous this supplemental coverage is. For instance, while most Medicare Advantage plans offer supplemental dental , cost-sharing and coverage can vary. Some plans don’t cover services such as extractions and endodontics, which includes root canals. Most plans that cover these more extensive dental services require some combination of coinsurance, copayments and annual limits.

Even when information is fully available, mistakes are likely.

Part D beneficiaries often fail to accurately evaluate premiums and expected out-of-pocket costs when making their enrollment decisions. Past work suggests that many beneficiaries have difficulty processing the proliferation of options. A person’s relationship with health care providers, financial situation and preferences are key considerations. The consequences of enrolling in one plan or another can be difficult to determine.

The trap: Locked out

At 65, when most beneficiaries first enroll in Medicare, federal regulations guarantee that anyone can get Medigap coverage. During this initial sign-up, beneficiaries can’t be charged a higher premium based on their health.

Older Americans who enroll in a Medicare Advantage plan but then want to switch back to traditional Medicare after more than a year has passed lose that guarantee. This can effectively lock them out of enrolling in supplemental Medigap insurance, making the initial decision a one-way street.

For the initial sign-up, Medigap plans are “guaranteed issue,” meaning the plan must cover preexisting health conditions without a waiting period and must allow anyone to enroll, regardless of health. They also must be “community rated,” meaning that the cost of a plan can’t rise because of age or illness, although it can go up due to other factors such as inflation.

People who enroll in traditional Medicare and a supplemental Medigap plan at 65 can expect to continue paying community-rated premiums as long as they remain enrolled, regardless of what happens to their health.

In most states, however, people who switch from Medicare Advantage to traditional Medicare don’t have as many protections. Most regulations permit plans to deny coverage, impose waiting periods or charge higher Medigap premiums based on their expected health costs. Only Connecticut, Maine, Massachusetts and New York guarantee that people can get Medigap plans after the initial sign-up period.

Deceptive advertising

Information about Medicare coverage and assistance choosing a plan is available but varies in quality and completeness. Older Americans are bombarded with ads for Medicare Advantage plans that they may not be eligible for and that include misleading statements about benefits.

A November 2022 report from the U.S. Senate Committee on Finance found deceptive and aggressive sales and marketing tactics, including mailed brochures that implied government endorsement, telemarketers who called up to 20 times a day, and salespeople who approached older adults in the grocery store to ask about their insurance coverage.

The Department of Health and Human Services tightened rules for 2024, requiring third-party marketers to include federal resources about Medicare, including the website and toll- phone number, and limiting the number of contacts from marketers.

Although the government has the authority to marketing materials, enforcement is partially dependent on whether complaints are filed. Complaints can be filed with the federal government’s Senior Medicare Patrol, a federally funded program that prevents and addresses unethical Medicare activities.

Meanwhile, the number of people enrolled in Medicare Advantage plans has grown rapidly, doubling since 2010 and accounting for more than half of all Medicare beneficiaries by 2023.

Nearly one-third of Medicare beneficiaries seek information from an insurance broker. Brokers sell health insurance plans from multiple companies. However, because they receive payment from plans in exchange for sales, and because they are unlikely to sell every option, a plan recommended by a broker may not meet a person’s needs.

Help is out there − but falls short

An alternative source of information is the federal government. It offers three sources of information to assist people with choosing one of these plans: 1-800-Medicare, medicare.gov and the State Health Insurance Assistance Program, also known as SHIP.

The SHIP program combats misleading Medicare advertising and deceptive brokers by connecting eligible Americans with counselors by phone or in person to help them choose plans. Many people say they prefer meeting in person with a counselor over phone or internet . SHIP staff say they often help people understand what’s in Medicare Advantage ads and disenroll from plans they were directed to by brokers.

Telephone SHIP services are available nationally, but one of us and our colleagues have found that in-person SHIP services are not available in some . We tabulated areas by ZIP code in 27 states and found that although more than half of the locations had a SHIP site within the county, areas without a SHIP site included a larger proportion of people with low incomes.

Virtual services are an option that’s particularly useful in rural areas and for people with limited mobility or little access to transportation, but they require online access. Virtual and in-person services, where both a beneficiary and a counselor can look at the same computer screen, are especially useful for looking through complex coverage options.

We also interviewed SHIP counselors and coordinators from across the U.S.

As one SHIP coordinator noted, many people are not aware of all their coverage options. For instance, one beneficiary told a coordinator, “I’ve been on Medicaid and I’m aging out of Medicaid. And I don’t have a lot of money. And now I have to pay for my insurance?” As it turned out, the beneficiary was eligible for both Medicaid and Medicare because of their income, and so had to pay less than they thought.

The interviews made clear that many people are not aware that Medicare Advantage ads and insurance brokers may be biased. One counselor said, “There’s a lot of backing (beneficiaries) off the ledge, if you will, thanks to those TV commercials.”

Many SHIP staff counselors said they would benefit from additional training on coverage options, including for people who are eligible for both Medicare and Medicaid. The SHIP program relies heavily on volunteers, and there is often greater demand for services than the available volunteers can offer. Additional counselors would help meet needs for complex coverage decisions.

The key to making a good Medicare coverage decision is to use the help available and weigh your costs, access to health providers, current health and medication needs, and also consider how your health and medication needs might change as time goes on.

This article is part of an occasional series examining the U.S. Medicare system.

This story has been updated to remove a graphic that contained incorrect information about SHIP locations, and to correct the date of the open enrollment period.The Conversation

Grace McCormack, Postdoctoral researcher of Health Policy and Economics, University of Southern California and Melissa GarridoBoston University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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