The Medicare Part D Premium Payment (MDPP) Program provides assistance to qualified Medicare eligible clients. Assistance includes coverage of Medicare Part D premiums, certain Medical Out-Of-Pocket (MOOP) costs, and Supplemental/Medigap premiums.
Medigap is a supplemental health insurance policy that covers health care costs that traditional Medicare does not cover, such as co-payments, co-insurance, and deductibles. If you are enrolled in Medicare Parts A, B, and D, and have a Medigap premium of at least $1, you may be able to receive Medigap premium assistance through the MDPP Program.
Effective July 1, 2020, Senate Bill 407 requires Medigap bills to specify plan costs as separate line items. The MDPP Program Medigap premium assistance covers the medical portion of premiums only. Dental, vision, extra, and innovative costs are not covered by the MDPP Program.
MDPP Eligibility Requirements
- Be enrolled in CDPH’s Medication Assistance Program
- Be enrolled in a Medicare Part D Prescription Drug Plan*
- Not be receiving 100 percent assistance from Medicare Extra Help/Full Low Income Subsidy (LIS)
- Not be receiving full-scope Medi-Cal
*Please Note: Your plan must be from a participating Medicare Part D provider with a Part D monthly premium. For a listing of all participating plans, please visit: www.medicare.gov/find-a-plan/questions/home.aspx. If you have any questions regarding Medicare Part D, you may contact Medicare directly at (800) 633-4227.
Medicare Open Enrollment
Open Enrollment for Medicare is October 15, 2020 through December 7, 2020.
During this time, you may be eligible to make changes to your Medicare plan. For additional information, please visit: www.medicare.gov.
MDPP Documentation Requirements
If you are already enrolled in the MDPP Program, you do not need to submit any documentation to CDPH unless you made changes to your Medicare Part D or Medigap plan.
If you made changes to your Medicare Part D plan, you must provide an updated Client Attestation form indicating you are applying for MDPP. Updated Client Attestation forms may be submitted to your local Medication Assistance Program Enrollment Worker, or directly to the CDPH Medication Assistance Program.
If you made changes to your Medigap plan, you must provide an updated billing statement to your local Medication Assistance Program Enrollment Worker, or directly to the CDPH Medication Assistance Program.
How to Submit Documents
Work with your local Medication Assistance Program Enrollment Worker to submit documents electronically (THIS IS THE FASTEST AND PREFERRED METHOD), or
Email, fax, or mail the documents to CDPH:
P.O. Box 997426, MS 7704
Sacramento, CA 95899
Medicare Advantage Prescription Drug (MAPD) Plans
If you are enrolled in a MAPD plan, you must continue to pay your monthly medical and outpatient (Part B and C) premiums. MDPP cannot pay these premiums and only covers the discernable Part D portion. Please note: You should verify your monthly premium amount with your health plan and pay the exact amount. Otherwise, you may be terminated from the plan.
If the Social Security Administration (SSA) automatically deducts your monthly Medicare Part D premium payments, you will need to contact:
- your health plan to request direct billing, and
- SSA at (800) 772-1213, to stop your automatic deductions after confirming the CDPH MDPP Program has sent payment to your Medicare Part D Plan.
If you are enrolled in a MAPD plan, you will need to contact SSA at (800) 772-1213, to stop your automatic deductions for your Part D premium, after confirming the CDPH MDPP Program has sent payment to the health plan.
For questions about Medication Assistance Program eligibility and enrollment, please call:
- Your local Medication Assistance Program Enrollment Worker, or
- The Medication Assistance Program Client Services call center at (844) 421-7050. Client Services staff are available Monday – Friday, 8 A.M. – 5 P.M. (excluding holidays).