HICAP Online Interest Form

Health Insurance Counseling & Advocacy Program

Health Insurance Counseling & Advocacy Program (HICAP) services are available to current Medicare beneficiaries living in Santa Clara County; those about to become eligible for benefits; and anyone who wants to learn more about buying health insurance while planning for retirement.

HICAP is part of the national network of State Health Insurance Assistance Program (SHIP) and is the Santa Clara County source for unbiased and objective Medicare-related counseling and information. Please fill out the form to see how you qualify.

Please fill out the client Information below.