Medicare covers an annual screening for STIs, including HIV. Also, Medicare will cover sexually transmitted infection screenings and counseling. Medicare will cover screenings for gonorrhea, syphilis, chlamydia, and hepatitis B. These screenings fall under Part B as a preventive service. Coverage is for those who need short counseling sessions on STD/STI prevention. These counseling sessions consist of 2 individual 20-30-minute, face to face sessions at a high-intensity.
Does Medicare Cover Sexually Transmitted Infection Testing?
Medicare’s preventive care benefits include a yearly screening for gonorrhea, chlamydia, syphilis, and HIV. Part B covers the full cost of preventive care, as long as your doctor accepts Medicare assignment.
To be eligible for the screening, you must either be:
- Pregnant, or
- Have an increased risk of an STI
Many things can lead to an increased risk, including having more than one sexual partner and not using adequate protection.
Medicare pays for up to two 20 to 30-minute STD counseling sessions with a doctor each year. If you’re concerned about a sexually transmitted disease, talk to your doctor about getting screened.
Does Medicare Cover STD Testing?
Many people use the term STD, or sexually transmitted disease, to mean the same thing as STI. Technically, there’s a difference between the two.
An STI is a viral or bacterial infection. An STD is a more serious condition that can result from that infection. For example, HIV is a viral STI. If left untreated, it can lead to AIDS, which is an STD.
If your doctor suspects you have an STD, the doctor may order tests to confirm the diagnosis. Doctor visits and diagnostic testing are covered by Part B.
The Centers for Disease and Control Prevention (CDC) suggests STD screening for those who:
- Are ages 13-64
- Are sexually active
- Had multiple sex partners
- Got a new sexual partner
- Have a sex partner who is or has been infected with an STD/STI
- A man with a male sexual partner
- Are pregnant
- Use drugs/needles and share them with others
Does Medicare Cover HIV Testing?
Medicare covers an annual HIV screening test for everyone aged 15-65 who’s on Medicare. It also pays for a yearly screening for younger or older people at risk of contracting the virus. If you’re pregnant, you can have up to thee screenings during your pregnancy.
HIV testing is preventative service. You won’t pay anything for the test as long as your provider accepts Medicare assignment.
Does Medicare Cover Chlamydia Testing?
Medicare covers testing for both chlamydia and gonorrhea in women. Because mothers can pass either infection to an unborn child, Medicare pays for screenings for pregnant women under age 24 or at risk for STIs. Medicare will also pay for repeat screening for pregnant women.
Women of any age with an increased risk of STIs can get an annual screening.
Does Part D Cover STD and STI Medications?
Chlamydia, gonorrhea, and syphilis are bacterial infections that can be cured with antibiotics. Herpes is a viral infection that cannot be cured but can be managed with antiviral drugs.
Part D plans will usually cover both antibiotics and antivirals. These drugs are often available in lower-cost generic forms. Depending on your plan, you may have to pay a copay for your prescriptions.
HIV is an incurable virus that must be managed to prevent it from progressing to AIDS. Doctors prescribe antiretroviral therapy, or ART, to treat HIV. Antiretroviral medications are one of six classes of drugs protected under Medicare.
Part D plans must cover all drugs in protected classes. This ensures that HIV patients will always have access to lifesaving treatments.
Medicare Advantage and Sexually Transmitted Diseases or Infections
If you’re in a Medicare Advantage plan, you can still get an annual STI screening at no cost. Medicare Advantage plans must offer the same benefits like Medicare, but they can require you to use a healthcare provider in the plan’s network.
Prescription coverage is a feature of many Medicare Advantage plans. As with a standalone Part D prescription plan, you can expect your plan to cover many antibiotics and antivirals. Your prescription plan must cover antiretrovirals because they’re in a protected class.
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