HIV/AIDS Preventive Services

The Affordable Care Act requires coverage of recommended preventive services without cost-sharing for the following health plans:

  1. Non-grandfathered private health insurance plans – Most private insurance plans, including all plans on the Health Insurance Marketplace, and all group or individual health insurance plans that did not exist on March 23, 2010—or that have made significant changes to benefits, cost-sharing, or limits since that time—are required to cover services without cost-sharing.1,2
  2. Medicare – All USPSTF recommended services that have a Grade “A” or “B” and that are covered by Medicare must be covered without cost-sharing.3
  3. Medicaid expansion plans in states that expanded (i.e. Alternative Benefit Plans) – Medicaid expansion plans offered by states that extend Medicaid eligibility to non-elderly individuals with annual incomes at or below 133 percent of the federal poverty level ($16,040 for an individual or $32,718 for a family of 4 in 2017) are required to cover services without cost-sharing.4,5
  4. Traditional Medicaid plans – Those states that, at their option, cover without cost-sharing in their standard Medicaid benefit package all USPSTF-recommended services that have a Grade “A” or “B” and all ACIP-recommended vaccines receive an increase in their federal medical assistance for such services and vaccines.6

In addition to these services, private and public plans may cover other preventive services without cost-sharing.

Preventive services for HIV/AIDS that may be covered without cost-sharing, pursuant to Affordable Care Act (ACA) requirements.
Preventive Service Recommending Authority
(authorized under Section 1001 of the Patient Protection and Affordable Care Act)
Eligible Populations and Service Specifics Health Insurance Plans That Cover the Service Without Cost-Sharing
HIV Testing USPSTF
(Grade “A” Recommendation issued April 2013)
  • Screen for HIV infection in adolescents and adults aged 15 to 65 years.
    • Younger adolescents and older adults who are at increased risk should also be screened.
  • Screen all pregnant women for HIV, including those who present in labor who are untested and whose HIV status is unknown.7

(See USPSTF Final Recommendation Statement: Human Immunodeficiency Virus (HIV) Infection: ScreeningExternal for additional information.)

  • Non-grandfathered health insurance plans
  • Medicare Medicare covers a maximum of
    • one, annual, voluntary screening for all adolescents and adults between the age of 15 and 65, without regard to perceived risk.
    • one annual HIV screening for individuals <15 or >65 who are at increased risk of HIV.
    • three screenings for all pregnant women. 8
  • Medicaid expansion plans
  • Traditional Medicaid plans Optional
Women’s Preventive Services Guidelines
(December 2016)
Screen for HIV infection annually for all sexually active women.9(See Women’s Preventive Service GuidelinesExternal for additional information.)
  • Non-grandfathered private health insurance plans
  • Medicaid expansion plans
  • Traditional Medicaid plans Optional as above.
Bright Futures Recommendations for Pediatric Preventive Health Care, Supported by HRSA
(American Academy of Pediatrics, 2017)
Test sexually active adolescents for HIV (11-21 years of age).10Additionally, as per AAP StatementCdc-pdfExternal all adolescents should be screened once, between 16-18 years, making every effort to preserve confidentiality of the adolescent. Those at increased risk should be reassessed annually.11
(See Recommendations for Preventive Pediatric Health CareCdc-pdfExternal for additional information.)
  • Non-grandfathered private health insurance plans
  • Medicaid expansion plans
  • Traditional Medicaid plans Optional. However, in general, preventive services for children are covered, included as part of the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit for children; cost-sharing may apply in some cases.
Sexually Transmitted Infection (STI) and HIV Prevention Counseling USPSTF
(Grade “B” recommendation issued September 2014)
Provide intensive behavioral counseling for all sexually active adolescents and for adults who are at increased risk for sexually transmitted infections (STIs).12 

(See USPSTF Final Recommendation: Statement: Sexually Transmitted Infections: Behavioral CounselingExternal for additional information.)

  • Non-grandfathered private health insurance plans
  • Medicare Medicare covers up to two individual 20 to 30 minute, face-to-face, high intensity behavioral counseling sessions annually for Medicare beneficiaries for all sexually active adolescents and for adults at increased risk for STIs.13
  • Medicaid expansion plans
  • Traditional Medicaid plans Optional as above.
Women’s Preventive Services Guidelines
(December 2016)
Provide annual counseling on sexually transmitted infections, including HIV, to all sexually active women.9

(See Women’s Preventive Services GuidelinesExternal for additional information.)

  • Non-grandfathered private health insurance plans
  • Medicaid expansion plans
  • Traditional Medicaid plans Optional as above.
References
  1. 42 U.S.C. § 300gg–13External
  2. Coverage of Certain Preventive Services Under the Affordable Care ActExternal; U.S. Department of Health & Human Services
  3. 42 U.S.C. § 1395lExternal
  4. 42 U.S.C. § 1396aExternal
  5. Medicaid and Children’s Health Insurance Programs: Essential Health Benefits in Alternative Benefit Plans, Eligibility Notices, Fair Hearing and Appeal Processes, and Premiums and Cost Sharing; Exchanges: Eligibility and Enrollment.Cdc-pdfExternal 78 FR 42159; 42224-42226. July 2013
  6. 43 U.S.C. § 1396dExternal
  7. Final Update Summary: Human Immunodeficiency Virus (HIV) Infection: ScreeningExternal. U.S. Preventive Services Task Force. April 2013.
  8. National Coverage Determination (NCD) for Screening for the Human Immunodeficiency Virus (HIV) Infection (210.7)External. Centers for Medicare and Medicaid Services. April 2015.
  9. Women’s Preventive Services GuidelinesExternal. Health Resources and Services Administration December 2016.
  10. 2016 Recommendations for Preventive Pediatric Health CareCdc-pdfExternal. Committee on Practice and Ambulatory Medicine and Bright Futures Periodicity Schedule Workgroup. Pediatrics 2016;137
  11. Adolescents and HIV Infection: The Pediatrician’s Role in Promoting Routine Testing. American Academy of PediatricsCdc-pdfExternal. October 2011.
  12. Final Recommendation Statement: Sexually Transmitted Infections: Behavioral CounselingExternal. U.S. Preventive Services Task Force. December 2016.
  13. National Coverage Determination (NCD) for Screening for Sexually Transmitted Infections (STIs) and High-Intensity Behavioral Counseling (HIBC) to Prevent STIs (210.10)External. Centers for Medicare and Medicaid Services. November 2011.

Page last reviewed: May 2, 2018