Policy & Politics
Federal Health Plan, Medicare Do Not Cover Routine HIV Screening as Recommended by CDC, Bloomberg Reports
August 1, 2008
Medicare and federal health care plans that provide coverage under the Federal Employees Health Benefit Plan do not offer payment for routine HIV screening of people ages 13 to 64 -- a practice that was recommended by CDC in 2006 -- Bloomberg reports. According to Bloomberg, FEHBP provides coverage for 8.5 million employees, and Medicare provides coverage for 7.1 million disabled people under age 65. CDC revised its recommendations because risk-based HIV screening often was not covered by insurance, and doctors often did not know which of their patients were considered high risk. In addition, more people outside high-risk groups -- including women, minority groups and people living outside cities -- were contracting the virus.
Medicare also does not cover routine HIV screening, according to a spokesperson. Although most Medicare beneficiaries are older than age 65 -- the cut-off age under the CDC testing recommendations -- about seven million younger disabled beneficiaries should be screened under the recommendations, Bloomberg reports.
Cornelius Baker, a policy adviser at the National Black Gay Men's Advocacy Coalition, said that risk-based testing particularly endangers blacks in the U.S., about 2% of whom are living with HIV. Many physicians do not ask patients about their sexual behavior and make assumptions about who is at risk of HIV, Baker said, adding that blacks who do not consider themselves at risk will not be tested unless offered routine screening. "Some doctors are still making irrational decisions about HIV testing, deciding whether to screen someone based on what he or she looks like," Baker said, adding, "I can't imagine any African-American not being screened for sickle-cell disease; why not for HIV, which is higher in prevalence?"
According to Branson, not following the CDC guidelines allows HIV to spread and prevents HIV-positive people from early diagnosis and treatment. "It's a real paradox when one big federal agency makes a recommendation that another big federal agency won't support," John Bartlett, a Johns Hopkins University physician, said. He added, "I think they've got to catch up. It's a disease that's lethal, and one of the major problems with HIV today is late entry into care."
Some private insurers -- including UnitedHealth Group, Aetna and Cigna -- began covering routine HIV screening soon after the CDC guidelines were released, according to Bloomberg (Lauerman/Goldstein, Bloomberg, 7/31).
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This article was provided by Henry J. Kaiser Family Foundation. It is a part of the publication Kaiser Daily HIV/AIDS Report. Visit the Kaiser Family Foundation's website to find out more about their activities, publications and services.