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Does Medicare Cover STIs?

According to the Centers for Disease Control and Prevention (CDC), one in five Americans have a sexually transmitted infection (STI) of some kind. These infections can range from herpes and cold sores to HIV and AIDs. That same study estimates that the total lifetime medical costs of STIs acquired in 2018 alone would amount to nearly $16 billion. This isn’t just a problem for younger people, either. The rate of STIs among seniors in the United States has reached historic levels, more than doubling in the past decade. This concern faces all populations and groups of people.

Knowing whether you or your partner are carrying an STI is important to both not spread the infection, but also to receive treatment. But as we noted above, STIs can become expensive to treat and, though you won’t be paying $16 billion yourself, it helps to have some form of coverage to assist with those costs. Depending on the type of STI, your health circumstances or your age, you may rely on Medicare for coverage. Does Medicare cover screenings and treatment for STIs?

Note: We’ll be using the term STI throughout this article, but some may be more familiar with the phrase sexually transmitted disease (STD). Just know that these two are generally interchangeable, though STI is more accurate.

STI Screenings

We’ll start with the good news first. Medicare Part B will cover outpatient screenings for STIs including chlamydia, gonorrhea, syphilis, or hepatitis B annually. We’ve previously discussed Medicare Part B’s coverage of hepatitis, including hepatitis B, and the screenings and vaccines that go along with it. For the other STIs named, Medicare will cover a screening once every 12 months or at certain points if you’re pregnant. You qualify for this coverage if you’re pregnant or at an increased risk of an STI. In either case, your doctor must accept Medicare assignment and order the test. If you qualify for coverage, Medicare will cover your costs for screenings, meaning you’ll pay nothing out of pocket.

Medicare covers two individual sessions, held face to face and running for about 20 to 30 minutes each session.

Much like the hepatitis B vaccine, Medicare can cover another preventive service called high-intensity behavioral counseling. To be covered by this, you must be a sexually active adolescent or an adult at increased risk from STIs. Medicare covers two individual sessions, held face to face and running for about 20 to 30 minutes each session. These sessions are generally educational to teach sexual risk reduction and avoidance techniques, as well as guidance on how to change sexual behavior to be healthier.

What Counts as “Increased Risk”

For both the screenings and counseling sessions, we discussed that there was a need for the beneficiary to either be pregnant or at an increased risk. Obviously, we know what it is to be pregnant, but an increased risk is a little vague. Luckily, the national coverage determination (NCD) for STI screening and counseling defines what can count as increased risk, though the final decision is up to your doctor. While each infection discussed in the NCD has specific qualifiers, it also sets out what they consider to be increased or high risk, which can be any of the following:

  • Multiple sexual partners
  • Inconsistent use of barrier protection (like condoms)
  • Having sex under the influence of drugs or alcohol
  • Having sex in exchange for money or drugs
  • Having had an STI within the past year
  • IV drug use
  • Men who engage in sex with a same sex partner and engage in high-risk sexual behavior

For the four infections mentioned in the NCD — chlamydia, gonorrhea, syphilis, and hepatitis B — pregnancy is a qualifying circumstance for the screenings, specifically when the pregnancy is known and then during the third trimester. This is true for pregnant people considered at an increased risk and under 24 years of age (specifically for chlamydia and gonorrhea).

What About Medications?

If you have caught an STI, treatment will generally come in the form of antibiotics and antiviral drugs. Antiviral drugs are more commonly used for HIV and herpes to suppress the symptoms and keep the conditions under control. They do not cure the conditions. We’ll discuss HIV treatment more specifically in another article. Antibiotics are more commonly used for chlamydia, gonorrhea, and syphilis.

If your doctor prescribes them, there’s a very good chance your plan will have some form of coverage.

Medicare Part D and Medicare Advantage plans with prescription drug coverage may have you covered should you need treatment for an STI. Since these plans are offered by private companies, it’s impossible to give a specific price you’d owe or even if they’re guaranteed to be covered. If your doctor prescribes them, there’s a very good chance your plan will have some form of coverage. If this is something you’re concerned about, we suggest looking closely at your plan’s coverage to see if there’s adequate coverage for your needs. You can always explore your options with the Medicareful Plan Finder and talk to a licensed insurance agent to learn about what’s available to you.

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STIs are incredibly common in the United States, and if you’re sexually active and qualified as an increased risk, it’s a good idea to stay on top of your status. Whether that’s getting annual screenings, taking counseling services, or practicing safe sex, we can do our part to make sure the people we’re intimate with aren’t at risk.

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