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If you have HIV/AIDS, you may have questions about what benefits, and coverage are available to you under Medicare. It’s our job to make understanding Medicare and Medicare enrollment easy.

Pre-Existing Conditions and Medicare Eligibility

Eligibility for Medicare enrollment is based on factors such as United States citizenship and time spent paying into Social Security. Pre-existing medical conditions such as HIV or AIDS aren’t a factor for eligibility in Medicare. If you’re a U.S. citizen who is turning 65 years old, or younger than 65 and on disability, you are likely eligible for Medicare.

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Original Medicare and HIV/AIDS Coverage

If you have HIV/AIDs and are eligible for Medicare, you are eligible for all the standard care that Medicare Parts A and B offer. There are some medical needs unique to those who have HIV/AIDS. Medicare covers annual HIV testing for all beneficiaries between the ages of 15 and 65. For beneficiaries outside of that age range (younger than 15 and older than 65), testing is covered if you are at increased risk for HIV/AIDS. Asking to be tested may be enough to qualify you for a covered test.

Medicare and Antiretroviral Therapy Prescriptions

Original Medicare doesn’t include coverage for prescription drugs. To get these benefits, you can enroll in a Medicare Prescription Drug Plan (Part D), or a Medicare Advantage Plan with prescription drug coverage (MAPD).

Medicare plans are currently required to cover all approved antiretrovirals (ARVs) as a protected drug class. You may be able to get assistance with prescription costs through Extra Help or the Ryan White AIDS Drug Assistance Program.

Additional Benefits with Medicare Advantage

Original Medicare (Parts A and B) doesn’t include coverage for dental, vision, or hearing. Medicare Advantage Plans are offered by private insurance companies and include all the coverage Original Medicare offers, often with additional benefits like fitness plans, medical transportation, over-the-counter benefits, and much more. Some of these plans may be available with $0 premiums, deductibles, and copays. In those cases, you would be able to receive additional benefits at no additional cost.

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Enrollment Eligibility

Annual Enrollment Period (AEP)

Medicare Annual Enrollment Period runs each year from October 15 to December 7. What is the Annual Enrollment Period vs. Open Enrollment Period?

Initial Enrollment Period (IEP)

Your Initial Enrollment Period generally surrounds your 65th birthday but may occur if you otherwise become eligible for Medicare for the first time.

Special Enrollment Period (SEP)

You may be eligible if you experience a qualifying life event such as moving to a new zip code, losing employer coverage, or change in Medicaid status.

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Last Updated: November 1, 2022 MULTIPLAN_ETQEZMwebsite_0722_M