Golden Rule Services

HIV testing is integral to prevention, treatment, and care. Knowledge of one’s HIV status is important for preventing the spread of disease. Studies show that those who learn they are HIV positive modify their behavior to reduce the risk of HIV transmission. Early knowledge of HIV status is also important for linking those with HIV to medical care and services that can reduce morbidity and mortality and improve quality of life. U.S. Department of Health and Human Services guidelines recommend starting treatment as soon as one is diagnosed with HIV and new research (the Strategic Timing of AntiRetroviral Treatment study or START) has underscored the importance of starting treatment early. Recent policy decisions have expanded health insurance coverage of HIV testing, meaning that people with health insurance – both public and private – have greater access to testing. And, where insurance is not available, HIV testing can often be obtained at no cost.  Source:  Kaiser Fact Sheet, "HIV Testing in the United States," June 2015

HIV testing that is “medically necessary” – recommended by a physician due to risk – is generally covered by insurance. For those without insurance, HIV testing can be obtained at little or no cost in some settings (e.g., stand-alone HIV testing sites, mobile testing clinics).

• Private Insurance: The ACA requires that all private plans (except those that are grandfathered meaning they were in place before the ACA was passed and have made no significant changes to coverage) must cover routine HIV testing without cost-sharing.
  
• Medicaid: While all state Medicaid programs must cover “medically necessary” HIV testing, state coverage of “routine” HIV screening varies because it is an optional benefit under Medicaid. A recent analysis has found that more than two thirds of state Medicaid programs do cover routine HIV screening.
  
• Medicare: In April 2015, CMS expanded Medicare coverage to include annual HIV testing for beneficiaries ages 15-65 regardless of risk, and those outside this age range at increased risk. Additionally, Medicare will cover up to three tests for pregnant beneficiaries.
  
  Source:  Kaiser Fact Sheet, "HIV Testing in the United States," June 2015
  

The U.S. Centers for Disease Control and Prevention (CDC) recommends routine HIV screening in health-care settings for all adults, aged 13-64, and repeat screening at least annually for those at high risk (e.g., CDC says that sexually active gay and bisexual men may benefit from more frequent testing, such as every 3 to 6 months). CDC recommends that all HIV screening be voluntary, and opt-out (patient is notified that the test will be performed and consent is inferred unless the patient declines) vs. opt-in (test is offered to the patient who must explicitly consent to an HIV test, often in writing).  Source:  Kaiser Fact Sheet, "HIV Testing in the United States," June 2015