HICAP: Health Insurance Counseling & Advocacy Program

HICAP: Health Insurance Counseling & Advocacy Program

What is HICAP?
HICAP is a federal- and state-funded volunteer-based program. HICAP was established in 1984 to provide information about the myths and realities of Medicare, private health insurance companies, and provide legal advice and representation when necessary. There is a HICAP-type program in every state. Outside of California our program is also called “SHIP,” State Health Insurance Assistance Program.

HICAP counseling covers the following issues:

  • Your rights as a health care consumer
  • Your Medicare benefits and rights
  • Private Medigap (Medicare supplemental) insurance
  • Medicare Advantage HMO plans (Part C of Medicare)
  • Medicare prescription drug plans (Part D of Medicare)
  • Long-term care insurance
  • Information about health plan choices and health care rights
  • Low Income programs that provide relief for the Part B (medical coverage) premium and Part D, prescription drug benefit
  • Advocacy for denial of medical coverage, medical care, and problems with payments to providers.
  • Referrals for legal help and representation at Medicare appeals and administrative hearings
  • Other resources available in Contra Costa County
  • Community education, including Welcome to Medicare presentations and presentations on how to save money on prescription drug costs.

As advocates HICAP will write letters and make telephone calls to assist in getting disputed or denied Medicare-related medical bills paid. HICAP assists with billing Medicare supplemental insurance, helps beneficiaries understand their rights and obtain them, and when all other avenues have been exhausted, will represent beneficiaries in Medicare legal actions.

Contra Costa HICAP services are available to anyone receiving Medicare, regardless of their age, in Contra Costa County. Assistance is provided to family members, caregivers, and friends who are concerned about someone on Medicare. Counseling from HICAP is free, and HICAP does not sell or endorse any products or services. HICAP cannot be associated with the insurance industry.

Why is HICAP needed?

Medicare was never intended to cover all health care costs. Medicare basic and supplemental insurance plans can be very complicated. HICAP provides unbiased information to help individuals make the best choice for their health care needs. Sometimes Medicare and insurance companies make mistakes in approving and denying applications and processing claims. Sometimes applications for medical and drug coverage may be wrongfully denied. HICAP is here to assist with Medicare-related questions and problems.

How can HICAP help your clients?

HICAP volunteers and staff provide one-on-one confidential counseling for Medicare recipients throughout Contra Costa County in senior and community centers. Home visits can be arranged for the homebound. Translation services may also be arranged.
Welcome to Medicare classes are particularly useful in providing a framework to help people new to Medicare decide which choices are best for their individual health care needs. These classes provide information about how other health insurance, (including employer plans, retirement plans, VA, Tricare for Life, and COBRA), may or may not coordinate with Medicare.

When should your client contact HICAP?

Contact HICAP when you are about to turn 65 or otherwise become eligible for Medicare, have a question or a problem regarding your Medicare rights, have a denial for medical care services or when you need information to make an informed decision regarding your health plan such as your Medicare HMO or Supplemental Health Insurance. HICAP is available for group or organizational presentations.

The HICAP Mission is to provide accurate and objective counseling, advocacy and assistance with Medicare, supplemental health insurance, long term care insurance and related health coverage plans for Medicare beneficiaries, or anyone 60 years and over, and to educate the public on Medicare and health insurance issues.

HICAP counselors are volunteers who go through mandatory training and are registered with the California Department of Aging. Contact HICAP if you are interested in volunteering! HICAP is a program of the Contra Costa County Area Agency on Aging, the California Department of Aging, and is sponsored nationally by CMS, the Centers for Medicare and Medicaid Services