The purpose of this memo is to inform AIDS Drug Assistance Program (ADAP) enrollment workers that effective upon release of this memo the California Department of Public Health (CDPH), Center for Infectious Diseases (CID), Office of AIDS (OA) has expanded MDPP Program benefits to include the payment of Extra and Innovative Medigap premiums.
A supplemental Medicare policy (Medigap) is private insurance that helps pay some of the health care costs that are not covered by traditional Medicare, like copayments, coinsurance, and deductibles. Some Medigap policies include additional coverage, commonly referred to as "Extra" or "Innovative" benefits. These benefits can include but are not limited to hearing aids, vision, dental, and miscellaneous discounts at pharmacies. Extra or Innovative benefits portion of a Medigap plan were to be paid for by the client.
New and existing MDPP clients will now be eligible to receive assistance with their portion of their Medigap insurance premiums, including Extra and Innovatitive premiums.
General Program Requirements
- Active ADAP enrollment
- Active MDPP Program eligibility (if a client is deemed 100% Low Income Subsidy(LIS) they are no longer eligible.)
- Active Medigap plan, if applying for Medigap premium assistance
Documentation Requirements for Medigap Premium Payment Assistance
The most recent Medigap billing statement must be uploaded in full to AES as a Work Item. Ensure that all pages with premium information are included.
Enrolling a Client with a Medigap Plan into MDPP
At the time of MDPP enrollment, the enrollment worker should ask the client if he/she has a Medigap plan that they would like premium payment assistance with. If yes, the client will be required to submit the following supporting documentation to an ADAP enrollment worker or CDPH. Upload via Work Item in AES:
- Completed ADAP Attestation form
- Most recent Medigap billing statement
Once the ADAP Advisor verifies the completed forms, the client will be enrolled into MDPP and the ADAP Advisor will enter Medigap information from the Medigap billing statement into AES.
Disenrolling a Client with a Medigap Plan from MDPP
If the client dis-enrolls from MDPP mid-year, any open Medigap plan(s) must be closed prior to AES disenrollment. If an enrollment worker becomes aware that a client no longer has MDPP, or is no longer eligible for ADAP or MDPP, notify your ADAP Advisor to close the Medigap plan.
If you have any questions regarding the information provided in this memo, please contact your OA Advisor.
Sharisse Kemp, MSW
ADAP Branch Chief
California Department of Public Health