HICAP is the Health Insurance Counseling and Advocacy Program administered by Council on Aging Silicon Valley.

Health Insurance Counseling and Advocacy Program (HICAP) provides unbiased information to help you make an informed decision for your individual health care needs.

Council on Aging Silicon Valley's Health Insurance Counseling and Advocacy Program (HICAP) serves:

• Current Medicare beneficiaries

• Adult children and other representatives of Medicare beneficiaries

• People about to become eligible for Medicare or planning for retirement

• People younger than 65 years old who are eligible for Medicare due to a disability

• Service providers, such as social workers, nurses, doctors, and healthcare advocates working with Medicare beneficiaries

• People needing information on long-term care insurance

Health Insurance Counseling and Advocacy Program (HICAP) provides individual counseling and assistance on all Medicare health insurance issues as well as community education services. HICAP does not sell, endorse, or recommend any specific insurance product.

A Medigap policy is health insurance sold by private insurance companies to fill gaps in original Medicare coverage and is designed to cover the Medicare co-payments and deductibles.

Medicare Advantage Plans are health plan options like an (HMO or PPO) approved by Medicare and offered by private companies. These plans are part of Medicare and are sometimes called “Part C” or “MA plans.” Medicare pays a fixed amount for your care every month to the companies offering Medicare Advantage Plans and they in turn are responsible for your health care. Medicare Plans include:

• Preferred Provider Organizations (PPO) Plans

• Health Maintenance Organization (HMO) Plans

• Medical Savings Account (MSA) Plans

• Special Needs Plans (SNP)

The different enrollment periods for Medicare are as follows:

• Initial Enrollment Period begins three months before the month of the 65th birthday and ends three months after the month of the 65th birthday. The initial enrollment period is seven months, including the month of the person’s 65th birthday.

• Special Enrollment Period (SEP) for Those Who Still Work begins the first day of the first month the person is no longer enrolled in the employer health plan, and ends eight months later (or six months in the case of people with disabilities whose group plan is involuntarily terminated.

• General Enrollment Period is for persons who miss his or her initial enrollment period or special enrollment period. This may be done only during January – March of each year. If a person enrolls in a general enrollment period Medicare coverage will be effective July 1 of that calendar year.

• Late Enrollment – An individual may enroll during her/his initial enrollment period or special enrollment period without penalty. Those who do not enroll during these specified periods, but enroll in a later general enrollment period, will have to pay a monetary penalty.

Medicare offers prescription drug coverage (Part D) for everyone with Medicare. To get Medicare drug coverage, you must join a plan run by an insurance company or other private company approved by Medicare. Each plan can vary in cost and drugs covered. If you want Medicare drug coverage, you need to choose a plan that works with your health coverage.

Companies that offer Part D plans define the benefits that they provide, including the drugs they cover and the cost-sharing they charge.

In 2009, you enter the coverage gap when the total cost of your prescription drugs – including what you have paid plus what has been paid for your drugs by your Medicare drug plan on your behalf – goes over $2,700. You remain in the coverage gap until what you spend out of pocket in 2009 – excluding what your Medicare drug plan has paid on your behalf – reaches $4,350. If your total out-of-pocket costs exceed $4,350 in 2009, you get catastrophic coverage.

Help is available for people with lower incomes and limited savings. In 2009, individuals qualify if their income is below $16,245 and they have assets of less than $12,510. Couples qualify for extra help if their income is below $21,855 and assets are less than $25,010. Depending on the level of need, premiums, deductibles, co-insurance, and coverage gaps may be reduced or eliminated. Assets include items like checking, savings, CDs, IRAs, and 401Ks, but exclude items like houses and necessary cars.

Beneficiaries who have both Medicare and Medi-Cal are often referred to as “dual eligibles” or “Medi-Medi’s. Medicare is the beneficiary’s primary coverage. Medi-Cal acts as the secondary coverage and pays for Medicare co-payments and deductibles plus some benefits that Medicare does not cover. Med-Cal also pays the Medicare Part B premium for those with full Medi-Cal.

Long-term care insurance is designed to pay benefits for various types of care received in a variety of locations:

• In skilled nursing facilities or residential care facilities for the elderly;

• At home, through home health care, personal care and homemaker services;

• Hospice care;

• Respite care; and

• In the community, such as adult day care, adult day health care, or Alzheimer’s day care.

Some Long-Term Care insurance policies cover most of these types of care or services, while some LTCI policies cover only one or two kinds.