People who need Medicare coverage for HIV medications and other prescription drugs typically have two options for coverage: enroll in a Medicare prescription drug plan (Medicare Part D) or enroll in a Medicare Advantage plan (Medicare Part C) that covers prescription drugs.
Most prescription medications, including antiretroviral drugs used to treat HIV, are not covered by Original Medicare (Medicare Part A and Part B).
Medicare Part A and Part B don’t typically cover any prescription drugs you might buy at a retail pharmacy.
In order to get coverage for prescription drugs, such as HIV medication, you can do one of the following.
Plan benefits, coverage and availability can vary where you live. Be sure to check with your plan carrier to find out if your HIV medication is covered by your plan and find out what costs may be involved.
Medicare Part B (medical insurance) does cover one HIV screening per year if you’re enrolled in Medicare Part B and meet one of the following conditions:
If your HIV screening is covered by Medicare, you pay nothing for the test if your doctor accepts Medicare assignment. A doctor or health care provider who accepts assignment agrees to accept the Medicare-approved amount as full payment for covered services.
Medicare Advantage plans also cover at least one HIV screening per year based on the above qualifications. Some plans may provide additional HIV-related care services, but they may or may not be available in your area.
A licensed insurance agent can help you look for Medicare Advantage plans in your area that provide the benefits you are looking for, which could include plans that cover HIV medication.
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1 Jacobson, Gretchen, et al. Medicare Advantage 2019 Spotlight: First Look. (Oct. 16, 2018). Kaiser Family Foundation. Retrieved from www.kff.org/report-section/medicare-advantage-2019-spotlight-first-look-data-note.
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