UPDATED BENEFIT INFORMATION: Screening for the Human Immunodeficiency Virus (HIV) Infection

According to a new federal regulation, ADVANTAGE Health Solutions must cover the screening for the HIV Infection in accordance with the policy indicated below.

For Members in our Medicare Advantage HMO Plans: The in-network cost-sharing to our members for this screening will be $0.00 (no cost to you).

If you have questions concerning this policy, please contact Member Services at 1-800-523-7533 (TTY: 1-800-743-3333) from Monday-Friday, 8 a.m. to 5 p.m.

National Coverage Decision for Screening for the Human Immunodeficiency Virus (HIV) Infection

The Centers for Medicare and Medicaid Services (CMS) has determined that the evidence is adequate to conclude that screening for HIV infection is reasonable and necessary for early detection of HIV and is appropriate for individuals entitled to benefits under Part A or enrolled under Part B.

Therefore CMS will cover both standard and U.S. Food and Drug Administration (FDA)-approved HIV rapid screening tests for:

1. Annual voluntary HIV screening of Medicare beneficiaries at increased risk for HIV infection per USPSTF guidelines:

o Men who have had sex with men after 1975;

o Men and women having unprotected sex with multiple [more than one] partners;

o Past or present injection drug users;

o Men and women who exchange sex for money or drugs, or have sex partners who do;

o Individuals whose past or present sex partners were HIV-infected, bisexual or injection drug users;

o Persons being treated for sexually transmitted diseases;

o Persons with a history of blood transfusion between 1978 and 1985;

o Persons who request an HIV test despite reporting no individual risk factors; and

2. Voluntary HIV screening of pregnant Medicare beneficiaries when the diagnosis of pregnancy is known, during the third trimester, and at labor.