Does Medicare Cover HIV Medication?

• by Christian Worstell
• November 10, 2023
• 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, Medicare beneficiaries 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 when you visit MyRxPlans.com.
  
  
• Enroll in a Medicare Advantage plan with prescription drug coverage
  Medicare Advantage plans cover everything that Medicare Part A and Part B cover, and some plans may offer additional benefits Original Medicare doesn't cover.
  
  Although some Medicare Advantage plans may cover additional benefits, not all plans include prescription drug coverage.
  
  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 covers 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.

About the author

Christian Worstell is a senior Medicare and health insurance writer with MedicareAdvantage.com. He is also a licensed health insurance agent. Christian is well-known in the insurance industry for the thousands of educational articles he’s written, helping Americans better understand their health insurance and Medicare coverage.

Christian’s work as a Medicare expert has appeared in several top-tier and trade news outlets including Forbes, MarketWatch, WebMD and Yahoo! Finance.

Christian has written hundreds of articles for MedicareAvantage.com that teach Medicare beneficiaries the best practices for navigating Medicare. His articles are read by thousands of older Americans each month. By better understanding their health care coverage, readers may hopefully learn how to limit their out-of-pocket Medicare spending and access quality medical care.

Christian’s passion for his role stems from his desire to make a difference in the senior community. He strongly believes that the more beneficiaries know about their Medicare coverage, the better their overall health and wellness is as a result.

A current resident of Raleigh, Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism.

If you’re a member of the media looking to connect with Christian, please don’t hesitate to email our public relations team at Mike@tzhealthmedia.com.

 

 

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