Human Immunodeficiency Virus (HIV) attacks the body’s immune system and can lead to Acquired Immunodeficiency Syndrome (AIDS). Screening can help determine if you need medical treatment for HIV.

Eligibility

Medicare Part B covers an annual HIV screening if you are:

• Age 15-65
• Younger than 15 or older than 65, and at increased risk
• Or, pregnant

Note: Pregnant women are eligible to receive coverage for up to three HIV screenings during pregnancy.

Costs

If you qualify, Original Medicare covers HIV screenings at 100% of the Medicare-approved amount when you receive services from a participating provider. This means you pay nothing (no deductible nor coinsurance). Medicare Advantage Plans are required to cover HIV screenings without applying deductibles, copayments, or coinsurance when you see an in-network provider and meet Medicare’s eligibility requirements for the service.

During the course of your screening, your provider may discover and need to investigate or treat a new or existing problem. This additional care is considered diagnostic, meaning your provider is treating you because of certain symptoms or risk factors. Medicare may bill you for any diagnostic care you receive during a preventive visit.

Medicare coverage of PrEP

PrEP medication using antiretroviral drugs prevents HIV infection in high-risk individuals. PrEP is currently covered under Part D. CMS proposed in July 2023 that both oral and injectable forms of PrEP be covered by Part B as a preventive service and have no deductible or coinsurance cost-sharing. This proposal is still under review.