I am taking pre-exposure prophylaxis (PrEP) to prevent HIV, but I received a bill for cost sharing for the labs I needed to start the medication. Is this allowed?

Post enrollment issues | Individual Health Insurance | Employer-Sponsored Coverage |

No, not under a plan that complies with the Affordable Care Act. PrEP is a recommended preventive service and must be covered without cost sharing. This includes coverage of the medication, the medical visit, and the essential support services (HIV testing, STD testing, hepatitis testing, kidney function testing, and adherence counseling), all without cost sharing. You can appeal this claim starting with the internal appeals procedure your insurer must provide you. Federal guidance currently requires insurers to cover all required labs for PrEP without cost sharing. (CMS, Affordable Care Act Implementation FAQ – Part 47, July 19 2021).

Individuals with no coverage
Individuals with coverage
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Post enrollment issues