Health Insurance Counseling & Advocacy Program (HICAP)

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 when necessary and appropriate provide legal advice and representation. There is a HICAP-type program in every state. Outside of California our program is also called “SHIP”, State Health Insurance Assistance Program.

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 you make the best choice for your individual 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.

Who does HICAP serve?

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.

How can HICAP help you?

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.

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, PPO, PFFS (private fee for service) health plans (Part C of Medicare)
  • Medicare prescription drug plans
  • Long-term care insurance
  • Information about health plan choices and health care rights
  • Subsidies for those with limited means for the Part B (outpatient services) premium, co-insurance and deductibles and Extra Help for Medicare prescription drug coverage (Part D).
  • 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 classes

The Welcome to Medicare classes are particularly useful in providing a framework to help you decide which choices are best for your individual health care needs. These classes provide information about how other health insurance, including employer plans, retirement plans, VA, Tricare for Life, and COBRA, coordinates with Medicare.

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 you understand your rights and obtain them, and when all other avenues have been exhausted, will represent you in Medicare legal actions.

When should you 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.

For additional information, call
800-510-2020 or
visit our website: www.cchicap.org