Medicare to consider expanding coverage of HIV

Patricia Hafermann • Benefit Specialist

Advocates who work with HIV/AIDS issues have requested that Medicare consider paying for HIV screening of all Medicare beneficiaries. The proposal would have Medicare pay for HIV test for all beneficiaries without considering behaviors, pregnancy, or whether or not someone is high risk.

Currently, Medicare only covers HIV tests in limited situations. Pregnant women with Medicare are eligible to receive the HIV screening lab test free-of-charge up to three times a year (first, at the date of the first pregnancy test at her doctor’s office; second, at a follow up appointment with her doctor during her third trimester; and last, during labor.)

Otherwise, Medicare covers HIV screening for people once a year if they ask for the test. Medicare will also cover the test for people identified as “at increased risk for the infection” (such as gay and bisexual men, injection drug users, or people with multiple sexual partners). Under current coverage policies, a person who wants to be tested more than once a year or whose doctor recommends multiple tests, may have to pay for the test.

Under the current policy, a person must proactively ask their doctor for the test or identify themselves as at-risk or pregnant. “Making HIV testing more routine could empower patients and providers to talk more about their behavior and the need for testing,” said John Peller, interim CEO of AIDS Foundation of Chicago.

Medicare is currently accepting public comments on the suggestion until Sept. 3 and plans to release an initial coverage decision by Feb. 4, 2015, and a final decision by May 5, 2015.

The CDC estimates that by 2017, more than half of those living with HIV will be 50 years old and older approaching Medicare eligibility. The CDC also explains that:

Americans age 50 and older have many of the same HIV risk factors as younger Americans.

Persons aged 55 and older accounted for 19 percent (217,300) of the estimated 1.1 million people living with HIV infection in the United States in 2010.

Older Americans are more likely than younger Americans to be diagnosed with HIV infection later in the course of their disease.

There is a large population of people receiving Medicare due to a disability who would also receive the benefit of extended screening coverage. If Medicare approved expanded HIV screenings, about 9 million people under the age of 65 who receive Medicare due to a disability would be impacted.

For more information on HIV among older adults, visit: www.cdc. gov/ hiv/ pdf/ library_ factsheet_ HIV_%20AmongOlderAmericans. pdf.

If you have any additional questions, you may call Pat Hafermann, Elderly Benefits Specialist with the Aging and Disability Resource Center at (920) 467-4076. Sources: Published with permission from the Legal Services Team at the Greater Wisconsin Agency on Aging Resources’ Elder Law & Advocacy Center

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