The History of HICAP and its Mission

Comments we hear from our clients are “why doesn’t anyone know about your program” and “please conduct more marketing about your program.”

What most people do not know is that the Health Insurance Counseling and Advocacy Program (HICAP) program has been serving Medicare beneficiaries since 1985. Senator Agnos passed a state law in 1984 to launch a pilot program to assist Medicare beneficiaries with their federal insurance coverage.

In 1988, HICAP of San Mateo County was one of the first offices to open in the State of California to assist Medicare beneficiaries with their questions and help them file medical claims. The first official Program Manager registered with California Department of Aging (CDA) was Mary Pappas of San Mateo County.

learn about hicap

In 1990, Federal Omnibus Budget Reconciliation Act (OBRA) authorized the Centers for Medicare and Medicaid Services (CMS) to make grants available for State Health Insurance Assistance Programs (SHIPs). SHIP is the national name for the HICAP program. Then in 1995-96, CA Welfare and Institutions Code revisions (Mello-Granlund Older Californians Act – AB 2800) defined HICAP in California, as we know it today.

HICAP has three primary objectives: 1) one-on-one counseling 2) community education 3) advocacy

According to California Department of Aging, HICAP came into existence because of inappropriate sales practices by insurance companies and agents that were taking advantage of Medicare beneficiaries because of their lack of knowledge about Medicare, selling them excess insurance plans, and using aggressive marketing tactics.

At that time, Centers for Medicare and Medicaid (CMS) had not designated a federal or state agency to help Medicare beneficiaries directly with their benefits and options. In turn, it became apparent there was a need to create a program that explained the basics of Medicare to existing beneficiaries, people imminent of Medicare and/or their representatives without having to worry someone was trying to sell them a Medicare product or providing biased information.

The premise of the HICAP program is to provide unbiased information to Medicare beneficiaries without selling or recommending insurance plans or companies. The safe place to learn about Medicare and its supplemental options.

Federal, State and local agencies that oversee the HICAP program:

  • Center for Medicare and Medicaid (CMS)
  • Administration of Community Living (ACL)
  • California Department of Aging (CDA)
  • San Mateo County Aging & Adult Services (Area Agency on Aging)
  • Local Provider Organization-Self-Help for the Elderly

HICAP serves:

  • Medicare beneficiaries
  • Representatives of Medicare beneficiaries
  • People who are imminent of Medicare
  • Individuals who are eligible for Medicare due to a disability
  • Persons planning for retirement and interested in purchasing a long-term care insurance policy or existing policy holders

Medicare Counseling

The Health Insurance Counseling & Advocacy Program (HICAP) is a state-sponsored, volunteer-supported program that provides free counseling to people with Medicare about their benefits, rights and options, and other health insurance related questions.

HICAP provides unbiased information to help you make an informed decision about your individual health care needs. The California Department of Aging (CDA) provides funding and oversight of the program through contracts with local Area Agencies on Aging (AAA) offices who administer the local HICAP programs.

HICAP does not sell, endorse, or recommend any specific insurance product or companies.

Trained HICAP counselors will explain the basics of Medicare to you and help you navigate the Medicare maze.

Topics discussed at a “New to Medicare” counseling appointment:

  • Original Medicare: Part A & B
  • Medicare Advantage Plans (Part C)
  • Medicare Supplemental Insurance Policies (Medigap)
  • Medicare Prescription Drug Program (Part D)
  • Coordination of Benefits with an employer health plan, COBRA, retiree plan and Medi-Cal

HICAP also provides assistance with the following:

  • Long-Term Care Insurance Policies
  • Billing issues
  • Appeals

HICAP counselors prescreen clients for the following programs:

  • “Extra Help” for prescription assistance
  • Medicare Savings Program for Part A and/or Part B premium assistance
  • Medi-Cal

Make an appointment

Schedule a one-on-one appointment with a registered HICAP counselor by clicking on the “contact us” button below

Presentation Topics

HICAP provides free community education to the public about Medicare. This includes civic clubs, congregations, independent living community centers, companies, medical facilities and community-based agencies.

Samples of Community Presentations:

  • New to Medicare
  • Transitioning to Medicare from Covered CA
  • What is HICAP
  • Long-Term Care Insurance Policies
  • Medicare and Retiree plans
  • How Medicare coordinates with Medi-Cal
  • Enrollment Periods: Don’t let it cost you
  • Understanding the Medicare Advantage Open Enrollment Period
  • The annual Medicare Open Enrollment Period
  • Understanding Part D – Cost Structures (30min)

Presentation Request

To schedule a community presentation with a HICAP Community Educator (CE) click on the link below.