​The purpose of this memo is to inform AIDS Drug Assistance Program (ADAP) enrollment workers that effective January 1, 2025, the California Department of Public Health (CDPH), Center for Infectious Diseases (CID), Office of AIDS (OA) has expanded MPPP benefits to include the payment of Part D premiums above the benchmark threshold to ADAP clients that are deemed Extra Help/Full Low-Income Subsidy (LIS).

 Clients will have until February 28, 2025, to apply for MPPP with a January 1, 2025, start date. Applications received after February 28, 2025, will have a payment start date beginning the month their application is submitted.

Background

The Medicare Premium Payment Program (MPPP) assists qualified Medicare eligible clients with coverage of Medicare Part D and/or Medicare Advantage (Part C) premiums, certain medical out-of-pocket (MOOP) costs, standalone Dental and combined Dental and Vision premiums, and Medigap premiums (including Extra and Innovative premiums). Currently, clients that are deemed Extra Help/Full LIS are eligible for No-Cost Medicare Part D coverage through prescription benchmark plans. ADAP advised clients to enroll into a no-cost benchmark plan when clients were deemed Extra Help/Full LIS and would reject their MPPP application.

Program Update

Effective January 1, 2025, eligible ADAP Medicare clients that are deemed Extra Help/Full LIS can select any Medicare Part C or D plan of their choice and are no longer limited to no-cost benchmark plans. Clients that select a plan with a monthly Medicare Part D premium above $0, after all subsidies are applied, will be eligible for MPPP regardless of being deemed Extra Help/Full LIS. Deemed Extra Help/Full LIS clients approved for MPPP will be eligible for all MPPP benefits, including:​

• Medicare Part D and Medicare Advantage (Part C) premiums (up to $2,996)
• Part B MOOP expenses
• Standalone Dental and combined Dental & Vision premiums (effective 7/1/24)
• Medigap premiums (including Extra or Innovative premiums) (up to $2,996)

Note: The threshold of $2,996 per month applies to the total combined premiums of the client's Medicare Part D premium, Medicare Advantage premium, and Medigap premiums (including dental, vision, extra, and innovative premiums) effective January 1, 2025.

Clients should evaluate their plan selection to determine what will provide the best coverage before considering changing Medicare coverage to participate in MPPP. ADAP Advisors and Enrollment Workers cannot steer clients to select a specific health plan. Clients can be referred to the Department of Aging's Health Insurance Counseling and Advocacy Program (HICAP) for assistance with benefits navigation to find the best fit for them. HICAP can be reached at 1-800-434-0222.

 General Program Requirements

• Client must have active ADAP eligibility
• Client must have active Medicare Part C / D plan
• The client's Medicare Part C / D premium information must be available through Centers for Medicare and Medicaid Services (CMS)

Enrolling a Client into MPPP

At the time of MPPP enrollment or re-enrollment, the enrollment worker should ask the client if they have a Medicare Part D or Medicare Advantage plan that they would like premium payment assistance with. If yes, the client will be required to submit the required supporting documentation to an ADAP enrollment worker or CDPH. The enrollment worker will upload the following required documentation in the ADAP Enrollment System (AES) via “MPPP Supporting Documentation" Work Item for new applications, or “MPPP Premium/Plan Change" Work Item if changing plans:

• Completed ADAP Attestation form with “Applying for MPPP" selected

 Once the ADAP Advisor verifies the completed forms, the client will be enrolled into MPPP.

 Please refer to common scenarios and questions below that can help determine if a client is eligible for MPPP.
Scenario 1:

An ADAP client receives a notice that they are deemed eligible for 100% low-income subsidy effective January 1, 2025 through December 31, 2025.

 This client can elect to enroll in a Medicare Part D benchmark plan with no out-of-pocket premium costs. Selecting a plan with no remaining premium cost after subsidies are applied would make this client ineligible for MPPP.

 OR

 This client can select a Medicare Part C or D plan, other than a no-cost benchmark plan, that has a remaining premium after subsidies are applied and MPPP will cover the remaining cost.

 Scenario 2:

An ADAP client was previously denied MPPP due to being deemed or having 100% LIS and has been paying out-of-pocket to keep their preferred plan.

 The client can submit an updated client attestation form to request MPPP enrollment. MPPP will begin covering the remaining premium balance for their Part D plan along with any Medigap, or dental and vision premiums. Payment will begin the first day of the month the application is submitted. MPPP cannot retroactively pay premiums made by clients that were no qualified for MPPP prior to January 1, 2025.

 If you have any questions regarding the information provided in this memo, please contact your OA Advisor.

Thank you,

​​

Joseph Lagrama

ADAP Branch Chief

California Department of Public Health