Contact HICAP for Open Enrollment Help

We can help you with Medicare Open Enrollment. HICAP, the Health Insurance Counseling and Advocacy Program, provides free, unbiased education, counseling, and advocacy about Medicare and related health insurance.
Please use this form to submit a question or a request for assistance with Open Enrollment only. We will respond generally within 4 to 5 business days. Please do not use this form for any issues not related to Open Enrollment. We will not be able to respond to other issues.
Complete the form below. An *asterisk indicates a required field. Do not put any personal information on this form, such as Medicare number or insurance member number.
Name*
First Name Last Name
Zip Code*
Please enter your HOME Zip Code
Year of Birth (example: 1947)*
Your Email Address*
Enter Email Confirm Email
Phone*
Enter the best phone number to be reached on week days.
How do you prefer HICAP to contact you?
(check all that apply)
- PHONE
- EMAIL
If we need to contact you by phone, what are the best times to reach you.
(examples: "weekday mornings", or "after 3 pm")
Would you use ZOOM Video Conferencing to talk with a Counselor?
- YES
Please tell us how HICAP can help you with your Medicare Open Enrollment.*
Use this form only for help with Open Enrollment, such as a review of the best Drug Plan, a comparison of Medicare Advantage Plans, or help with changes to your plan. Please give us a brief summary. A counselor will contact you for additional details. Do not include any personal information such as Medicare number.
PLEASE NOTE: It may take several days, or even up to a week, for you to hear from us. Please do not submit a second form, or call our phone number. Multiple requests from the same person will slow down the response. Thank you for your cooperation.
Comments
This field is for validation purposes and should be left unchanged.

Open Enrollment 2021

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