Medicare provides coverage for various healthcare screenings and tests, including those for sexually transmitted diseases (STDs), also known as sexually transmitted infections (STIs).
People commonly use the terms STD and STI to describe health conditions that transmit between individuals through sexual activity.
As some sexually transmitted health conditions often do not produce any symptoms, STI is becoming the preferred term. However, Medicare does not distinguish between the two terms regarding coverage.
Medicare covers STI screenings that may include:
- blood tests
- urine tests
- genital swabs
The type of test depends on what the healthcare professional is investigating.
Medicare sets guidelines for coverage, and a person may have some additional out-of-pocket expenses.
We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:
- Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
- Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
- Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
The different parts of Medicare provide coverage in certain situations.
Medicare Part A
Part A covers inpatient hospital costs. Usually, Part A does not cover STI screening, but if a person is admitted to a hospital and receives the test as part of their inpatient care, Medicare will cover the costs.
Medicare Part B
Part B provides coverage for outpatient services, such as preventive testing and screenings, including STI testing.
Medicare Advantage (Part C)
Part C, also known as Medicare Advantage, is the alternative to original Medicare.
Private insurance companies administer Medicare Advantage plans. While specific coverage may vary among plan providers, Medicare requires that all policies have at least the same coverage as parts A and B.
This requirement means that Medicare Advantage plan benefits include STI testing.
Medicare Part D
Part D prescription drug plans do not cover STI testing, but they usually cover any medically necessary medication that a doctor prescribes to treat an STI.
A person does not pay anything for STI testing if they have either a Part B or Medicare Advantage plan, as long as they meet Medicare’s eligibility requirements.
Medicare waives deductibles and copayments for these preventive services.
Medicare covers tests for the following STIs:
- chlamydia
- gonorrhea
- syphilis
- hepatitis B
Medicare also covers the cost of an HIV test once a year for people aged 15–65 years and those outside of this age range who have an increased risk of HIV.
Also, during pregnancy, a person may have three HIV screenings.
In most cases, Medicare Part B provides yearly coverage for the costs of STI testing when an individual who is pregnant or at high risk of contracting an STI receives a referral from their healthcare provider.
High risk
A person’s healthcare provider will help determine whether they are at an increased risk of contracting an STI.
The Preventive Services Task Force note several factors that may increase a person’s risk. These include:
- having multiple or anonymous sexual partners
- having sex under the influence of drugs or alcohol
- inconsistent use of barrier protection, such as condoms, during sex
- IV drug use (for hepatitis B)
- high prevalence of STIs in a community
- the person having had an STI within the last year
Pregnancy
Medicare also covers STI testing at certain times during pregnancy.
For Part B to cover the costs, a doctor must provide a referral, and a Medicare-certified healthcare professional must administer the test.
Usually, people need to wait a few days for STI test results. Medicare then covers treatment following a positive test. The type of treatment necessary may vary depending on the specific condition.
For example, chlamydia, syphilis, and gonorrhea develop due to bacterial infections, which require treatment with antibiotics. When viruses cause STIs, such as herpes, a doctor may prescribe antiviral medications. Medicare covers the cost of both of these types of drugs.
Medicare Part D plans generally cover the medications that doctors use to treat STIs, but some out-of-pocket costs may apply.
If an infection or disease becomes severe enough to require inpatient care, Medicare Part A will cover the eligible costs.
An STI may transmit from person to person with the exchange of bodily fluids during sex.
As individual sex practices and risks vary, the recommendations for the frequency of testing also vary. An individual should talk with their doctor to determine how often they should consider testing.
In general, the
- People aged between 13 and 64 years: Recommendations include testing at least once a year for HIV.
- Females younger than 25 years who are sexually active: The CDC recommend yearly tests for gonorrhea and chlamydia.
- Females 25 years and older with risk factors: Recommendations include a test yearly for chlamydia and gonorrhea.
- During pregnancy: Recommendations include HIV, syphilis, and hepatitis B tests in early pregnancy. The CDC also recommend gonorrhea and chlamydia testing for those at high risk.
- Sexually active bisexual or gay males: Recommendations include testing once a year for gonorrhea, chlamydia, and syphilis.
- People who share drug equipment or engage in unprotected sex: The CDC recommend HIV testing yearly.
Primarily, Medicare Part B covers STI testing. Prevention, early diagnosis, and treatment for STIs can help prevent further health complications.
Depending on a person’s circumstances, age, and risk factors, their doctor may recommend a specific frequency of STI testing.
Usually, a person pays nothing for an STI test, with Medicare waiving the associated deductibles and copayments.