Health Insurance Counseling & Advocacy Program

Program Code

The Health Insurance Counseling and Advocacy Program (HICAP) program code is 3905100.

Program Description

HICAP is a consumer-oriented program providing Medicare and related health insurance counseling and education. HICAP offers the following services:

Community Education

About Medicare, including Medicare-related health insurance, long-term care insurance, long-term care planning, and access to Taking Care of Tomorrow, A Consumer’s Guide to Long-Term Care

Individual Health Insurance Counseling

About Medicare, including Medicare Parts A and B, Medicare supplemental insurance plans (Medigaps), Medicare Health Plan (Medicare Advantage and Prescription Drug Plan) comparisons, Medicare Savings Programs, Extra Help with medication costs, Medicare and Medi-Cal benefits for dual-eligible beneficiaries, and comparisons of long-term care insurance policies

Informal Advocacy Services

For Medicare-related issues, including enrollment, disenrollment from Medicare Advantage or Medicare Prescription Drug Plans, claims, appeals, prescription drug exceptions, questions about hospital bills, and other related insurance coverage issues

Legal Assistance or Legal Referral

To assist individuals with legal questions related to their Medicare benefits

Program Benefits

The Program provides crucial education, one-on-one counseling, and assistance to individuals as they navigate the complex decisions in selecting Medicare health insurance, a prescription plan, and Medigap coverage. Each of these choices has a specific and individualized impact on services, cost-sharing, and premium structures that can change year-to-year or as an individual’s health status changes. The Medicare website and toll-free number are helpful consumer resources, but do not substitute for HICAP services.

Program Eligibility

Eligibility Criteria	Eligibility Requirement
Age	Counseling is provided to: Individuals 65 years of age or older and are eligible for Medicare Individuals younger than 65 of age with a disability and are eligible for Medicare Individuals soon to be eligible for Medicare Education events are available for individuals of any age
Income	No requirement
Other	No requirement

Program Funding

Funding Type	Funding Information
Source	State Health Insurance Assistance Program (SHIP) federal funds via Administration for Community Living (ACL) State Insurance Reimbursement Fund State HICAP Fund California Department of Insurance
Allocation Formula	Federal Funds — Base funding and remainder is allocated based on a proportional share of Medicare beneficiaries. State Funds — Base funding and remainder is allocated based on the methodology prescribed in the Budget Act of 2000.
Match Requirements	No requirement
Other	Not applicable
State Fiscal Year Cycle Funding Cycle	April 1 – March 31 (state and federal)

Program Statistics

Annual Number of Clients Served Per Counselor

HICAP Data	2022-23	2023-24
Number of Clients Counseled (Unduplicated) per Counselor	87	90
Number of Client Contacts per Counselor	180	187

Number of Active HICAP Counselors, Both Volunteer and Paid

Counselor Type*	2022-23	2023-24
Volunteer	409	403
In-Kind	19	11
Paid	153	147
Total	581	561

*"Counselor Type" reflects reflect data specific to those individuals categorized as Counselors with active user accounts during assessment period(s) and does not include non-counselors or non-counseling hours. Includes three types, (1) Volunteer, (2) In-Kind, and (3) Paid. Volunteer: Individuals who perform program functions without any compensation for their time and services. In-Kind: In-Kind Paid individuals are employed and paid for their HICAP work, but their employer is not receiving funds from their local HICAP office. Therefore, their employer is offering their time as an "in-kind" contribution. Paid: Individuals who are paid by their local HICAP office. Data fluctuations from previous reports are in part due to updated data and corrections in previous calculations.

Percentage of California's Medicare Population Receiving HICAP Services

HICAP Data	2022-23	2023-24
Total Clients Counseled (Unduplicated) i	46,744	49,852
Penetration Rate	0.71%	0.74%
Total Client Contacts ii	112,670	117,866
Penetration Rate	1.71%	1.75%
Estimated Persons Reached at Interactive Public and Media Events iii	126,189	105,173
Penetration Rate	1.91%	1.56%
Estimated California Medicare Beneficiaries iv	6,600,188	6,736,175

i Also known as "Clients Counseled (Unduplicated Intakes Only)" reflects data for the number of unduplicated clients/beneficiaries served through counseling services provided by registered HICAP counselors.

ii Also known as "Counseling Services (excluding Quick Calls)", reflects the number of HICAP counseling services provided to, or on behalf of, the client/beneficiary by registered HICAP counselors. Category is a performance metric for the federal SHIP grant.

iii "Estimated Persons Reached at Interactive Public and Media Events" reflects data specific to estimated number of people attending interactive events. Interactive events are Public and Media (PAM) events where interaction has occurred between a Counselor and the public. HICAP providers also conduct Non-Interactive Public and Media Events, which does not involve direct interaction with an individual, but these figures were not included due to the unreliable count of estimated number of listeners, readers, viewers, page views, post reach, flyer distributed, etc.

iv "Estimated California Medicare Beneficiaries" based on annual July Medicare eligible population data from CMS.gov Monthly Enrollment by State.

Program Fact Sheets - Statewide

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