- For all participants whose enrollment expired or was set to expire before August 30, 2020
- ADAP & PrEP-AP has extended eligibility to August 31, 2020
- OA-HIPP, EB-HIPP & MDPP enrollments have been extended through September 30, 2020
- New ADAP applicants can reach out by phone or email to an enrollment worker
- Find an Enrollment Worker Site here
- If you are having difficulty finding an enrollment worker, call 844-421-7050 for assistance
- Until July 15, 2020, applicants can provide their 2018 tax returns as proof of income for program eligibility
Have you heard of PrEP and wondered what it stood for?
PrEP stands for Pre-exposure prophylaxis. PrEP is a daily HIV prevention pill for those who are HIV-negative and want to reduce their risk of exposure to HIV. Research shows that, when taken consistently, PrEP provides protection from contracting HIV in a high percentage of individuals.
The California Department of Public Health Office of AIDS offers assistance to those without insurance to cover PrEP. You may be eligible to receive PrEP free of charge as part of the Patient Assistance Program, known as PrEP-AP. The program provides assistance with PrEP-related medical costs and other medications for the prevention of HIV and the treatment of sexually transmitted infections.
- California resident
- At least 18 years old
- Negative HIV/AIDS test result (dated within six months of the PrEP-AP application)
- Annual Modified Adjusted Gross Income (MAGI) cannot exceed 500% of the Federal Poverty Level
- Medication expenses are not fully covered by Medi-Cal or other third-party payers
- Enrolled in the manufacturer’s assistance program (if eligible)
If an individual is HIV+, the California Department of Public Health Office of AIDS has other programs to help pay for medication and health coverage related expenses: AIDS Drug Assistance Program (ADAP), Health Insurance Premium Payment program (OA-HIPP), Employer-Based Health Insurance Premium Payment (EB-HIPP), and Medicare Part D Premium Payment (MDPP) Assistance.
References and Resources:
On September 3, 2019, the California Department of Public Health, Office of AIDS released the AIDS Drug Assistance Program (ADAP) Client portal.
Using the portal, clients enrolled in ADAP can:
- View their client ID, enrollment site, enrollment worker contact information, eligibility status, and eligibility end date
- View the Insurance Assistance Program information if enrolled, including program type (OA-HIPP, EB-HIPP, or MDPP), insurance carrier, eligibility status, and eligibility end date
- Elect to receive automatic notifications about eligibility and re-enrollment
- Recertify if there are no changes to residency or health insurance and annual household income is within program limits
To request access to the Client Portal, contact the ADAP Call Center at 1-844-421-7050, Monday-Friday, 8:00 AM – 5:00 PM. After requesting access, the client will receive an email with a URL to the client portal. Using the link, the client will enter their email address as the username and a temporary password, and then be prompted to create a new password. Contact the ADAP Call Center, with any issues accessing the Client Portal.
For more information about ADAP, go to California Department of Health Office of AIDS webpage.
If you are interested in ADAP and not yet enrolled, contact an ADAP Enrollment Worker to apply. To find an Enrollment Worker in your area, go to ADAP Enrollment Site Locator.
Some Californians, individuals, and families enrolled in Covered California (Covered CA) plans are eligible for financial assistance to lower the cost of their health insurance. Anyone who receives financial assistance with Covered CA is required to file a federal tax return as a condition of eligibility.
Covered CA offers two main ways to get assistance with health care coverage costs:
- Premium Assistance (formally called the Advanced Premium Tax Credit or APTC) is a tax credit to reduce an individual’s monthly premium.
- Cost-Sharing Reductions is a subsidy to reduce an individual’s out-of-pocket costs (their copay’s, coinsurance, deductible and out-of-pocket maximum).
Important Information Regarding Premium Assistance and Tax Filing
All Covered CA consumers who receive Premium Assistance/APTC, must file federal taxes for each calendar year they receive the assistance. If they fail to file their taxes, they will lose their eligibility for Premium Assistance/APTC. The consumer will then be responsible for paying the full premium amount and will have a higher cost-sharing for health care services.
Covered CA has mailed warning notices to those who are at risk of losing their Premium Assistance/APTC. These notices were sent to consumers who in 2017:
- Received Premium Assistance/APTC in the calendar year but did not file a federal tax return for that year;
- Filed a federal tax return but did not include IRS Form 8962; or
- Requested an extension to file a federal tax return but did not end up filing the return.
Covered CA consumers who fall within any of these categories will have until May 15, 2019, to preserve their Premium Assistance/APTC by reconciling their premium assistance and contacting Covered California to attest to having done so.
If consumers fail to take these steps, they will receive another notice, in a pink envelope, that tells them when their financial assistance will end if no action is taken. Covered CA consumers who fail to take corrective action will lose their current financial help starting July 1, 2019.
This year’s health insurance enrollment cycle began on October 15, 2018, and ends on January 15, 2019. Enrolling is easy and may be done a number of ways:
- online at Covered CA
- by phone (1-877-453-9198)
- in-person with one of San Francisco’s many enrollment workers.
Covered CA Basics
Covered CA is the state’s health insurance marketplace where consumers may purchase new insurance, change insurance plans, or renew existing insurance coverage. Qualified individuals may also receive financial assistance to help pay for health insurance costs.
Health insurance plans available through Covered California are organized by metal tier—Bronze, Silver, Gold, and Platinum. Plans in the higher metal tiers have higher monthly premiums, but smaller co-pays. All plans sold through Covered CA provide essential health benefits including outpatient care, hospitalization, prescription drugs, laboratory tests, mental health care, and emergency services. There are five health carriers who offer a variety of plans in the County of San Francisco: Blue Shield, Chinese Community Health Plan, Health Net, Kaiser, and Oscar.
Sign Up and Renewal Dates
- Sign up by December 15, 2018, for coverage starting January 1, 2019
- Sign up by January 15, 2019, for coverage starting February 1, 2019
Need Help Paying For Health Insurance Costs?
Californians who are HIV-positive may access health insurance cost-savings programs through the California Office on AIDS. The AIDS Drug Assistance Program (ADAP) and Office of AIDS Health Insurance Premium Payment Program (OA-HIPP) help pay insurance premiums, medication costs, and other out-of-pocket expenses. Enrollment into these programs must be done through a certified enrollment worker.
Open enrollment can be a confusing time, regardless of who you are. If you are an HIV-positive San Francisco resident who needs assistance in exploring your options and/or enrolling in healthcare you can contact PRC for additional help and information: 415-777-0333.
On May 15, 2018, the Office of AIDS (OA) and AIDS Drug Assistance Program (ADAP) announced the implementation of an employer-based health insurance premium payment (EB-HIPP) Program. New and existing ADAP clients who are enrolled in an employer-based health insurance plan are now eligible to receive premium assistance for their portion of their insurance premium.
EB-HIPP will pay medical and dental premiums, and it will also pay for vision premiums that are included in a medical or dental premium. EB-HIPP It will also pay the even pays for medical out of pocket (MOOP) expenses!
Eligibility for EB-HIPP is based on the following requirements:
- Be enrolled in ADAP
- Be employed and enrolled in an employer-based insurance program
- Employment verified with paystub dated within last three months
- The employer must agree to participate in the EB-HIPP program
Medicare Part D Premium Payment Program (MDPP) Now Offers Medigap Premium Payment Program for ADAP Clients
Effective June 14, 2018, the Office of AIDS (OA) and AIDS Drug Assistance Program (ADAP) has also expanded their MDPP Program benefits to include payment of Medigap premiums. Medigap insurance is private insurance that helps pay for some of the health care costs that are not covered by traditional Medicare, such as copayments, coinsurance, and deductibles. New and existing MDPP clients will now be eligible to receive assistance with their Medigap insurance premiums, as well as medical out of pocket (MOOP) expenses for Medicare outpatient claims.
Note: EB-HIPP must pay the client’s portion of their premium in order for the client to receive MOOP benefits