Does Medicare Cover HIV Screenings?

Medicare Part B medical insurance will cover 100 percent of the Medicare-approved costs of one voluntary HIV screening test per year if you meet certain conditions. It will pay for up to three HIV tests per year for pregnant Medicare recipients.

If you meet the requirements, you pay no deductible, copayments or coinsurance for the screening. Medicare Advantage plans are also required to cover all these out-of-pocket costs so long as you meet these requirements and receive the HIV screening from one of your plan’s in-network health care providers.

The HIV screening must be done with tests approved by the U.S. Food and Drug Administration and ordered by your doctor or other qualified health care provider.

The health care professional administering the test and the supplier of the FDA-approved testing materials must also be eligible Medicare providers before Medicare will pay for the HIV screening.

Medicare covers HIV tests for beneficiaries who meet certain requirements.

You can receive one voluntary HIV screening per year if you are a Medicare beneficiary between the ages of 15 and 65, regardless of your risk for getting HIV.

If you are enrolled in Medicare and younger than 15, older than 65 or pregnant, you can receive one voluntary test per year if you are in a high-risk group for getting the virus.

If you are a pregnant Medicare beneficiary, you can receive a maximum of three voluntary HIV screenings at key points during your pregnancy regardless of your level of risk for contracting the virus.

HIV can be transmitted by sexual contact, through blood or blood products, and by infected mothers to their fetus during pregnancy or their infants at birth or through breast milk.

The Medicare guidelines were established to cover a wide range of possible risk factors even though many of the beneficiaries — such as pregnant women or those under the age of 65 – constitute a small percentage of overall Medicare beneficiaries.

There are three types of tests used in HIV screenings. Each is performed on blood or fluid taken from your mouth.

It can take anywhere from 10 days to 90 days after you’ve been exposed to HIV before a test can detect it in your system. The time varies from person-to-person and also based on what type of test is used.

The time between exposure to HIV and when a test can detect it is called the “window period.”

This period tells you the earliest and the latest time it takes before the virus shows up in different types of tests. This is effectively the earliest and the latest that you may test positive for HIV.

If you get a negative test result from an HIV screening, it’s important to wait until after your test’s window period closes to be tested again.