Medicare provides coverage for various healthcare tests and screenings, 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 individuals can transmit through sexual activity. As some of these conditions do not produce symptoms, STI is now the preferred term. However, Medicare does not distinguish between the two terms regarding coverage.
Medicare covers STI screenings, which may include blood tests, urine tests, or 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.
Glossary of Medicare terms
We may use a few terms in this article that can be helpful to understand when selecting the best insurance plan:
- Out-of-pocket costs: An out-of-pocket cost is the amount a person must pay for medical care when Medicare does not pay the total cost or offer coverage. These costs can include deductibles, coinsurance, copayments, and premiums.
- Deductible: This is an annual amount a person must spend out of pocket within a certain period before an insurer starts to fund their treatments.
- Coinsurance: This is the percentage of treatment costs that a person must self-fund. For Medicare Part B, this is 20%.
- Copayment: This is a fixed dollar amount a person with insurance 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. Still, if healthcare professionals admit a person to a hospital and the person receives the test as part of their inpatient care, Medicare will cover the costs.
Medicare Part B
Part B covers outpatient services, such as preventive testing and screenings. This includes STI testing when it meets certain criteria.
Medicare Part C (Medicare Advantage)
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:
Medicare also covers the cost of an HIV test once a year for people ages 15 to 65 years old 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 a healthcare professional.
High risk
A healthcare professional will help a person determine whether they are at an increased risk of contracting an STI.
The
- not consistently using condoms
- having multiple sexual partners
- having one or more sexual partner(s) at high risk of developing an STI
- having received an STI diagnosis within the last year
- belonging to a population that has a high STI prevalence
Pregnancy
Medicare also covers STI testing at certain times during pregnancy.
A doctor must provide a referral for Part B to cover the costs, 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 a virus such as herpes is the cause, 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.
Medicare Part A will cover the eligible costs if a condition becomes severe enough to require inpatient care.
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. Individuals can talk with a doctor to determine how often to consider testing.
A note about sex and gender
Sex and gender exist on spectrums. This article will use the terms “male,” “female,” or both to refer to sex assigned at birth. Click here to learn more.
In general, the
- People ages 13 to 64 years: Test for HIV at least once a year.
- Females younger than 25: Yearly tests for gonorrhea and chlamydia.
- Females 25 years and older with risk factors: Yearly tests for chlamydia and gonorrhea.
- Pregnant people: HIV, syphilis, and hepatitis B tests in early pregnancy, as well as gonorrhea and chlamydia testing for those at high risk of contracting those conditions.
- Sexually active males who identify as gay or bisexual or have sex with males: Yearly testing for gonorrhea, chlamydia, and syphilis.
- People who share injection drug equipment: Yearly HIV testing.
- People who have had oral or anal sex: Discuss throat and rectal testing options with a healthcare professional.
Medicare Part B primarily covers STI testing. Prevention, early diagnosis, and treatment of 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.