Medicare coverage of HIV screenings

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HIV stands for Human Immunodeficiency Virus, which attacks the body’s immune system and eventually leads to Acquired Immunodeficiency Syndrome (AIDS). Medicare covers annual HIV screenings for everyone with Medicare. The HIV screening is performed as a lab blood test and must be prescribed by your doctor or other health care provider.

Pregnant women with Medicare are eligible to receive the HIV screening lab test free of charge up to three times a year. First, at the date of the first pregnancy test at her doctor’s office, second, at a follow up appointment with her doctor during her third trimester and last during labor.

Although anyone with Medicare can ask for the HIV screening test and receive it free; it is recommended that people at high risk for HIV be screened. The United States Preventive Services Task Force believes that the following are risk factors that increase a person’s chance of contracting HIV.

If someone is a(n):

  • Man who had sex with men after 1975
  • Man or woman who has unprotected sex with multiple (more than one) partners
  • Past or present injection drug user
  • Man or woman who exchanges sex for money or drugs or who has sex partners who do
  • Individual whose past or present sex partners were HIV-infected, bisexual, or injection drug users
  • Individual being treated for a sexually transmitted disease or diseases
  • Individual with a history of blood transfusion between 1978 and 1985 and/or
  • Individual who request an HIV test despite reporting no individual risk factors, since this group is likely to include individuals not willing to disclose high-risk behaviors

Medicare Advantage (MA) plans cover all preventive services the same as Original Medicare. This means MA plans will not be allowed to charge cost-sharing fees (coinsurances, copays or deductibles) for preventive services that Original Medicare does not charge for as long as you see in-network providers. If you see providers that are not in your plan’s network, charges will typically apply.


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