Is PrEP for HIV covered by insurance?
Medication to prevent HIV, plus required labs and visits. Here’s how each kind of plan usually handles it.
- Employer or MarketplaceUsually covered
Yes, PrEP and its required tests and visits are usually covered at $0.
More details
PrEP has a USPSTF “A” rating, so non-grandfathered plans must cover it and related services (lab tests, adherence counseling) without cost sharing. Plans may use reasonable management such as preferring generics.
Cost: $0 in network for covered PrEP medications and related services.
- Original MedicareUsually covered
Yes, Medicare Part B covers PrEP for HIV at $0.
More details
Since 2024, covers HIV PrEP drugs and related counseling and screening visits for eligible people without cost sharing.
- Medicare AdvantageUsually covered
Yes, Medicare Part B covers PrEP for HIV at $0.
More details
Since 2024, covers HIV PrEP drugs and related counseling and screening visits for eligible people without cost sharing. plans must cover Medicare’s preventive services at $0 when you use an in-network provider.
Cost: $0 in network for the preventive service; follow-up care can have your plan’s copays.
- MedicaidUsually covered
Yes, Medicaid covers PrEP.
More details
All state Medicaid programs cover PrEP medications; some states require .
What usually has to be true
- Must be prescribed by a clinician.
- Plans may require a generic or preferred version first.
Good to know
- The required HIV and kidney-function tests are part of the $0 benefit.
Related
- STI testing · Screening for HIV, chlamydia, gonorrhea, syphilis, and hepatitis.
Sources
Typical rules for 2026 plans, checked against these sources on October 20, 2026. Your plan’s own documents decide.
- 1USPSTF A and B recommendations
U.S. Preventive Services Task Force
Services rated A or B by the Task Force, such as specified cancer screenings, PrEP for HIV prevention, and statin use for certain adults, generally must be covered without cost sharing by non-grandfathered plans.
- 2Preventive care benefits for adults
HealthCare.gov
Covered adult preventive services include blood pressure, cholesterol, colorectal cancer, depression, diabetes, HIV, hepatitis, and lung cancer screenings, immunizations, PrEP for HIV prevention, tobacco-cessation interventions, and obesity counseling, when criteria are met.
- 3HIV screenings
Medicare.gov
Part B covers HIV screening once every 12 months for eligible people at no cost; Medicare also covers HIV PrEP drugs and related services.
- 4Compare Original Medicare and Medicare Advantage
Medicare.gov
Medicare Advantage plans cover everything Original Medicare covers (except hospice, which Original Medicare continues to pay), usually use provider networks, often require referrals or prior authorization, and may offer extra benefits such as dental, vision, and hearing.
- 5Mandatory and optional Medicaid benefits
Medicaid.gov
States must cover mandatory benefits such as inpatient and outpatient hospital care, physician services, laboratory and X-ray services, home health, and nursing facility care; many other benefits, including adult dental, vision, and prescription drugs coverage details, are state options.
General information about how coverage usually works, not a decision about your plan. Your plan documents and insurer have the final word.