Plain version: the Health Insurance Counseling and Advocacy Program (HICAP) gives seniors free, unbiased help with Medicare. It sells nothing, so it is the place to send a client who wants a second opinion from someone with no stake in the sale.
What it is: the CDI outline describes HICAP as a federally mandated, state and federally funded program that provides free assistance to Medicare beneficiaries and their families concerning Medicare, Medicare Advantage, Medicare supplement insurance, prescription drug plans, Medi-Cal and long-term care insurance. HICAP is California's State Health Insurance Assistance Program (SHIP); its funding includes federal SHIP funds and state funds. Counseling is free, confidential and one-on-one, with no income requirement.
Services (Welfare and Institutions Code §9541):
- Community education.
- Counseling and informal advocacy.
- Referral or legal representation for Medicare appeals, Medicare-related managed care appeals, and life and disability insurance problems.
The statute sets a limit: representation and advocacy do not include filing lawsuits against private insurers or managed health care plans. The CDI outline adds that some HICAPs can also provide legal assistance on Medicare and Medi-Cal.
Who runs it and how to reach it:
The California Department of Aging administers HICAP, and services are provided locally by contracted agencies. Community education, individual counseling and some legal services are available in all 58 counties and are administered through the Area Agencies on Aging. The Department of Insurance helps fund the program but does not run it.
Help is by phone or in person: find a local office through the Department of Aging's county listing or call 1-800-434-0222. Counselors meet people by appointment at sites such as senior centers and libraries, and no referral is needed.