People With Medicare
What it is:
HIV, or Human Immunodeficiency Virus, is a virus that attacks a person's immune system.
Our immune systems are made up of several types of cells and organs that help us fight off everyday infections and diseases. HIV attacks one kind of these immune cells, called T-cells. T-cells help us fight infections and diseases.
Over time, HIV depletes the body's supply of T-cells, leaving fewer cells to fight infection and disease. This leads to AIDS, or acquired immunodeficiency syndrome.
AIDS is the final stage of the HIV infection. Then, a person may develop life-threatening infections and diseases.
Why the screening is important:
Once the virus is in your body, it can only be treated, not removed. If you are at risk, it is important for you to get tested each year. That way, if you are infected, you can get help right away.
If you get help early, you may not get AIDS until much later. Most people who have HIV and do not treat it will develop AIDS over time.
Yearly tests also help prevent the spread of HIV. More than one million Americans live with HIV/AIDS. But 1 in 5 people do not know they are infected. They may give it to other people without knowing.
Who is covered:
Medicare will pay for an HIV test if you:
- Are pregnant
- Are at high-risk for infection
- Ask for a test, for any reason
How often is it covered:
Medicare will cover an HIV test every 12 months, or every 3 months for pregnant women.
What you pay:
You pay nothing for cost of this test if you have Original Medicare and you see a doctor who "accepts assignment." Doctors who accept assignment agree to accept the amount that Medicare will pay for a visit or service (called the Medicare-approved amount) as payment in full.
If you are in a Medicare Advantage plan, the plan cannot charge you for this service as long as you see an "in-network" provider, meaning a doctor who has an agreement to treat people who belong to the plan. If you use a provider outside your plan's network, it may cost you money.
Learn more about HIV Screening on Medicare.gov.
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