Does Medicare Cover HIV Medication?

• by Christian Worstell
• December 9, 2021
• Reviewed by John Krahnert

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).

Does Medicare cover any prescription drugs?

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 medications like Truvada, Selzentry, Complera or Descovy, you can do one of the following.

• Enroll in a Medicare Part D prescription drug plan
  Medicare Part D plans are sold by private insurance companies. Part D plans help Medicare beneficiaries cover some of their prescription drug costs.
  
  You can compare Part D plans available where you live and enroll in a Medicare prescription drug plan online in as little as 10 minutes when you visit MyRxPlans.com.¹
  
  
• Enroll in a Medicare Advantage plan with prescription drug coverage
  Medicare Advantage plans cover everything that Medicare Part A and Part B cover, and most plans include coverage for prescription drugs.
  
  In fact, 90 percent of all Medicare Advantage plans offered in 2020 included prescription drug coverage.²
  
  Additionally, many Medicare Advantage plans help cover other services that may be important to people with HIV, such as vision, hearing, dental, and wellness benefits, which are not covered by Medicare Part A or Part B.
  
  Another benefit of Medicare Advantage plans is that they have an annual out-of-pocket maximum. An out-of-pocket maximum limits how much you can pay in a single year for your health care. There is no out-of-pocket maximum with Original Medicare.

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.

Does Medicare cover HIV testing?

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:

• You are age 15-65
• You are younger than 15 or older than 65 and are at an increased risk for HIV

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.

Find Medicare Advantage plans that cover HIV medication

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.

Or call 1-800-557-6059 1-800-557-6059 TTY Users: 711 24/7 to speak with a licensed insurance agent.

About the author

Christian Worstell is a licensed insurance agent and a Senior Staff Writer for MedicareAdvantage.com. He is passionate about helping people navigate the complexities of Medicare and understand their coverage options.

His work has been featured in outlets such as Vox, MSN, and The Washington Post, and he is a frequent contributor to health care and finance blogs.

Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism. He currently lives in Raleigh, NC.

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