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 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 the 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
Allocation Formula

Not applicable

Match Requirements

No requirement

Other

Not applicable

Cycle

April 1 – March 31 (federal)

July 1 – June 30 (State)

Program Fact Sheets - Statewide

Available Content:

Program Fact Sheets - Local Level

Program Narratives