When a person has Medicare, there may come a time they have questions or need an advocate.    Many may look online for information.  Some may reach out to a health insurance broker/agent to see if they can be a resource.  There is a free program available to California residents called HICAP (Health Insurance Counseling and Advocacy Program).  Similar programs are offered in other states sometimes called SHIP (State Health Insurance Assistance Program) or something else, so you don’t have to live in California to have this service. HICAP agencies provide help for people on Medicare through advocacy, conducting public policy research to support improved rights and protections of Medicare beneficiaries and their families and through education.

What services does HICAP offer?

Counselors are registered with the California Department of Aging.  They can meet with a person to help understand their Medicare benefits and options.  They can explain:

• Medicare benefits
• Health insurance terminology
• Supplemental insurance (secondary insurance or prescription drug coverage insurance)
• Billing and claims procedures
• Long-term care insurance

HICAP Counselors provide information, so people are able to make informed decisions. 

• They help people evaluate policies
• Assist people when dealing with providers
• Aid with medical records

The best part is that HICAP counselors’ services are free.  While they may help people evaluate their policy options, they will not sell you any products.  The decisions are ultimately yours since they will not make decisions for you.

When would you need Medicare help?

While it’s great to know this resource is out there, when would you need this service?   Medicare covers medical treatment, but it does not cover everything since there are deductibles and co-pays.  Plus, there is no coverage for non-medical services or prescription drugs.  Considering this, people should know what options are available to fill in the gaps in coverage.  This is where HICAP can help someone understand what their options are.

HICAP also keeps up-to-date with any changes in Medicare coverage and laws.  An example of this is on June 11, 2018, when CMS (Centers for Medicare and Medicaid Services) announced a change to the way that fee schedule amounts for DME (Durable Medical Equipment) are established, indicating that prices paid by other payers may be used to establish the Medicare fee schedule amounts for new technology items and services.  What does this mean?  It means that Medicare used to cover the cost of DME equipment such as walkers, commodes, ramps, beds, oxygen, etc., but now requirements need to be met for Medicare to cover DME equipment. Otherwise, it is an out-of-pocket expense for the recipient.  HICAP would help guide you on this.  Another example is when a person is transported via ambulance, and  HICAP can explain when Medicare will cover and not cover such transportation.

You are not alone as you go through this aging journey.  There are resources out there.  Let STAGES be your starting point.