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Medicare now covers some HIV testing

Medical experts hope the recently added benefit will persuade more people to check their HIV status.

By Francesca Lunzer Kritz

January 11, 2010

Medicare added a perk for some of its beneficiaries in late 2009 -- coverage of the cost of HIV testing for people at risk of contracting the virus.

Medicare beneficiaries might seem to be in an odd age bracket to be concerned about HIV, but Medicare also covers many disabled people under age 65. Further, the number of people over age 50 diagnosed with HIV each year is rising, according to the federal Centers for Disease Control and Prevention. "Older people also contract HIV and AIDS, so this new Medicare benefit is important," says Dr. Jonathan Mermin, head of HIV/AIDS prevention at the CDC. "And we also want to emphasize testing at younger ages." In 2006, the CDC recommended that everyone age 13 to 64 be tested at least once in his or her lifetime.

Health experts are hoping the Medicare coverage and other options for free and low-cost HIV testing will push people to check their HIV status. Mermin says too few people in the U.S. have been tested. Nationally, just more than 1.1 million people have HIV or AIDS, with 40,000 new cases each year. About 20% of people with HIV don't know they're infected.

In Los Angeles, 60,000 people have the virus, says Dr. Jennifer Sayles, medical director in the Los Angeles County Office of AIDS programs and policy.

Cost is generally not the main reason people give for not being tested, says Jennifer Kates, vice president and director of HIV policy at the Kaiser Family Foundation in Washington, D.C. More common are beliefs they couldn't possibly be infected, fears they'll learn they do have the virus and worries about being seen at a testing site. "But," says Kates, "couple any of those concerns with the need to pay out of pocket, and that will further push some people away from being tested."

The out-of-pocket cost for an HIV test usually runs $25 to $150. The upper range, says Sayles, would be likely for someone who tests positive, which would require a confirming retest and counseling about treatment and how to prevent infecting others. Going to a lab for a test without a doctor's recommendation may not be covered by insurance, says Sayles, so your best bet would be to get the doctor to give you a referral slip for the test. Many insurers will ask you to pay a co-pay, usually 20%.

Medi-Cal covers HIV tests ordered by a physician, says Gabriel McGowan, a spokesman for AIDS Project Los Angeles. And many community health centers offer the test free as well. Because not all health centers offer the test, find a testing center through the Los Angeles County office of AIDS programs and policy at www.hivla.org or (800) 367 AIDS [2437]. Although some insurers may limit the numbers of AIDS tests per year, centers affiliated with the Los Angeles County AIDS policy office do not. But Mermin suggests waiting eight to 12 weeks after a possible exposure to ensure that the virus can be de tected.

Although the free testing is a boon, the cost of treatment can reach hundreds of thousands of dollars. Free treatment is available as well. Learn more about those options via the website and number above.

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