Medicare PrEP Coverage: The Basics
In September 2024, CMS finalized a National Coverage Determination that adds PrEP to Medicare Part B's preventive services. This means:
- $0 cost-sharing for FDA-approved PrEP medications (oral and injectable)
- $0 for related services including HIV testing, kidney function tests, and provider visits for PrEP management
- No deductible applies to PrEP under Part B
Before this change: PrEP was covered under Medicare Part D (prescription drug plans), which meant copays, deductibles, and the coverage gap. The Part B coverage path now offers a completely free option.
Part B vs. Part D for PrEP
| Feature | Part B (new) | Part D |
|---|---|---|
| Cost to you | $0 | Varies (up to $2,100 annual OOP cap) |
| Deductible | None for preventive | Plan-specific |
| Covers labs/visits | Yes, at $0 | Separate Part B billing |
| Prior authorization | May be required | May be required |
| Best for | Lowest possible cost | Backup if Part B claim denied |
Your provider should bill PrEP under Part B for the best coverage. If there's an issue, Part D remains a backup option with the $2,100 annual OOP cap.
Medicare or not, PrEP is free
MISTR works with Medicare and all insurance types. Free consultation, free labs, free medication, free delivery.
ANDR735
Using this code at signup helps us achieve our mission of getting free PrEP out to all who need it.
HIV in Older Adults: Why PrEP Matters After 50
People over 50 accounted for approximately 17% of new HIV diagnoses in recent CDC data. Factors that increase risk in this age group include:
- Dating after divorce or the death of a partner
- Less consistent condom use (pregnancy is no longer a concern)
- Lower likelihood of being offered HIV testing by providers
- Biological factors: thinning vaginal and rectal tissue increases susceptibility
- Later diagnosis on average, which means later treatment
PrEP is approved for adults of all ages. If you're sexually active and at any risk of HIV exposure, age is not a reason to avoid PrEP.
How to Start PrEP on Medicare
- Talk to your doctor: Ask about PrEP at your next visit. Any primary care provider can prescribe it.
- Use telehealth: Services like MISTR accept Medicare and offer consultations from home.
- Request Part B billing: Make sure your provider bills PrEP services under Part B (not Part D) for $0 cost-sharing.
- Don't be shy: Providers sometimes assume older patients aren't at risk. Advocate for yourself — PrEP should be offered to anyone who asks.
PrEP from the comfort of home
MISTR offers telehealth consultations — no waiting room, no commute. Free for Medicare patients.
ANDR735
Using this code at signup helps us achieve our mission of getting free PrEP out to all who need it.