E. Health Insurance and Counseling Advocacy Program (HICAP)
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Key Takeaways
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Educational Objective
III.D.2. For HICAP, be able to identify that HICAP is 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: the educational services, consumer advocacy, and legal assistance provided; that the program is administered by the Department of Aging and operated locally by Area Agencies on Aging; and assistance by phone or in person, as well as legal assistance.
1. Who the Program Serves
The state Department of Aging is responsible for overseeing the Health Insurance Counseling and Advocacy Program (HICAP) — a federally mandated and state- and federally-funded program. In conjunction with local Area Agencies on Aging operated in each county in California, HICAP provides free assistance to seniors who are already receiving or are about to receive Medicare or Social Security benefits. HICAP provides consumer counseling related to the purchase of health insurance, long-term care insurance, Medicare, Medicare Advantage, Medicare supplement, or Medi-Cal insurance.
2. Cost of Program to Persons Served
Funding for HICAP is provided by the state and local governments, principally with state and local revenue and, to a lesser extent, with federal funds, and all services are provided without cost to clients. HICAP agencies do not sell, recommend, or in any other way transact insurance.
3. Function of Program
HICAP fulfills the following functions:
Free assistance — the program provides free individual counseling about Medicare and other health care issues. Counseling is available in every county in California, and the majority of HICAP counselors are trained and certified volunteers.
Education — free educational presentations are available to groups of Medicare beneficiaries, their families, and providers.
Consumer advocacy — the program handles complaints about abusive practices of agents or insurers, referring them, when appropriate, to state or local enforcement agencies for investigation of crimes such as twisting, misrepresentation, or financial abuse.
Legal assistance — HICAP counselors provide help with Medicare claims, appeals, denials, or delays of service or treatment. Their responsibility is also to give customers unbiased advice about Medicare Advantage plans, supplemental insurance, and long-term care, among other issues.
4. How to Locate a Program
A list of local HICAPs for each county in California is provided through www.calmedicare.org, a Medicare information website approved by the Department, which gives accurate and unbiased information about Medicare benefits for residents of California. Contact information for the local HICAP agencies can also be found at www.aging.ca.gov/hicap/countyList.aspx. The website also provides the statewide toll-free phone number available to anybody seeking help or free counseling on Medicare or other health care issues (800-434-0222).