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The month of December began with World AIDS Day, an international day of action on HIV and AIDS. When advising Medicare beneficiaries with the diagnoses of HIV and AIDS, be aware that Medicare covers a wide array of services, for those living with HIV/AIDS including the terminal stages of AIDS.  Services covered include hospital, skilled nursing facility, home health and hospice care.

In addition, various treatments under Part B, including but not limited to intravenous administration of drugs such as amphotericin B and ganciclovir for histoplasmosis and CMV retinitis, which are opportunistic infections associated with HIV/AIDS, are covered as Durable Medical Equipment.  Pumps used to infuse the medications are also covered under DME.  Also, beneficiaries with non-cancer diagnoses can be covered by the hospice benefit as long as certain criteria, such as six months or less of life expectancy, are met.

Under the new Medicare Part D drug benefit, many plan formularies contain coverage for antiviral medications associated with HIV/AIDS.  Importantly, CMS has issued guidance requiring Medicare Part D plans to have “all or substantially all” HIV/AIDS drugs on their formularies.  Check formularies for coverage before enrolling.

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