At a glance
The Affordable Care Act (ACA) includes several provisions aimed at improving coverage of, and access to, certain HIV preventive health services. These services and the health insurance plans that cover them without cost-sharing are summarized here in these Preventive Services Coverage Tables.
HIV testing
| Recommending Authority | Eligible Populations and Service Specifics | Plans That Cover Without Cost-Sharing |
|---|---|---|
| USPSTF (Grade “A”, June 2019) | Screen for HIV infection in adolescents and adults aged 15 to 65 years.
(See Human Immunodeficiency Virus (HIV) Infection: Screening for additional information.) |
Non-grandfathered private health insurance plans Medicaid expansion plans Traditional Medicaid plans* |
| Women’s Preventive Services Guidelines (December 2016) | Screen for HIV infection annually for all sexually active women.2
(See Women’s Preventive Service Guidelines for additional information.) |
Non-grandfathered private health insurance plans Medicaid expansion plans |
| Bright Futures/AAP Recommendations for Pediatric Preventive Health Care(March 2020) | Adolescents should be screened for HIV according to the USPSTF recommendations once between the ages of 15 and 18, making every effort to preserve confidentiality of the adolescent.
Adolescents ages 11 through 21 who are at increased risk of HIV infection, including those who are sexually active, participate in injection drug use, or are being tested for other sexually transmitted infections (STIs), should be tested for HIV and reassessed annually.3 (See Recommendations for Preventive Pediatric Health Care for additional information.) |
Non-grandfathered private health insurance plans Medicaid expansion plans Traditional Medicaid plans |
*Optional for adults, depending on state policy; however, preventive services for children are often covered as part of the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit for children.
HIV pre-exposure prophylaxis
| Recommending Authority | Eligible Populations and Service Specifics | Plans That Cover Without Cost-Sharing |
|---|---|---|
| USPSTF (Grade “A”, August 2023) | The USPSTF recommends that clinicians offer preexposure prophylaxis (PrEP) with effective antiretroviral therapy to persons who are at high risk of HIV acquisition.4
(See Prevention of Human Immunodeficiency Virus (HIV) Infection: Preexposure Prophylaxis for additional information.) |
Non-grandfathered private health insurance plans Medicaid expansion plans Traditional Medicaid plans* |
*Optional for adults, depending on state policy; however, preventive services for children are often covered as part of the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit for children.
Sexually transmitted infection and HIV prevention counseling
| Recommending Authority | Eligible Populations and Service Specifics | Plans That Cover Without Cost-Sharing |
|---|---|---|
| USPSTF (Grade “B”; August 2020) | Provide intensive behavioral counseling to prevent sexually transmitted infections (STIs) to all sexually active adolescents and for adults at increased risk for STIs.
(See Sexually Transmitted Infections: Behavioral Counseling for a discussion of risk factors.) |
Non-grandfathered private health insurance plans Medicaid expansion plans Traditional Medicaid plans* |
| Women’s Preventive Services Guidelines (December 2016) | Provide counseling on sexually transmitted infections, including HIV, for all sexually active women.
(See Women’s Preventive Services Guidelines for additional information.) |
Non-grandfathered private health insurance plans Medicaid expansion plans |
*Optional for adults, depending on state policy; however, preventive services for children are often covered as part of the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit for children.
- Human Immunodeficiency Virus (HIV) Infection: Screening; U.S. Preventive Services Task Force. June 2019.
- Women's Preventive Services Guidelines; Health Resources and Services Administration. December 2016.
- Bright Futures/AAP Recommendations for Pediatric Preventive Health Care; American Academy of Pediatrics. March 2020.
- Prevention of Human Immunodeficiency Virus (HIV) Infection: Preexposure Prophylaxis; U.S. Preventive Services Task Force. August 2023.
- Sexually Transmitted Infections: Behavioral Counseling; U.S. Preventive Services Task Force. August 2020.