Does Medicare Cover STD Testing?

Medicare coverage for STD and STI testing is available when medically necessary. Your Medicare benefits include HIV testing, sexually transmitted infection screenings, counseling, and more. Below, we review Medicare STD testing coverage and how to best utilize your benefits.

Is STD Testing Covered by Medicare?

Medicare Part B covers screenings for gonorrhea, syphilis, chlamydia, and hepatitis B, as these are preventive services. Benefits are available for those who need short counseling sessions on STD/STI prevention consisting of two individual 20 to 30-minute, face-to-face, high-intensity sessions.

For seniors with Medicare, understanding how your benefits cover your healthcare is important. Even if you do not have an STD or STI, there are routine healthcare tests and screenings that can help you maintain a responsible, healthier lifestyle.

Furthermore, whether or not you have an STD or an STI, because there is a difference, can depend on the healthcare services you require. Explore your options with Medicare regarding all aspects of your sexual health.

Medicare STD Testing

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. Your diagnosis will determine your treatment and coverage you receive from Medicare.

It’s important to understand the difference between the two, as the healthcare services you may need can differ depending on whether you have an STD or an STI. If your doctor suspects you have an STD, they may order tests to confirm the diagnosis. Doctor visits and diagnostic testing are covered by Medicare Part B.

The Centers for Disease and Control Prevention (CDC) suggests STD screenings for those who:

• Are the ages between 13 and 64
• Are sexually active
• Had/have multiple sex partners
• Have a new sexual partner
• Have a sex partner who is or has been infected with an STD/STI
• Individuals that were assigned male at birth and have or have been with a partner that was also assigned male at birth
• Anyone pregnant
• Those using drugs/needles that also share them with others

Does Medicare Cover STI Testing?

Medicare’s preventive care benefits include a yearly screening for several sexually transmitted infections. Medicare Part B covers the full cost of preventive care as long as your doctor accepts Medicare assignment.

This applies to seniors enrolled in both Original Medicare and Medicare Advantage. 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 of an STI, including having more than one sexual partner and not using adequate protection. Here are other common factors that can increase your risk:

• Engaging in unprotected sex
• History of STIs
• Suffering from sexual assault or rape
• Substance abuse impairing one’s judgment
• Using and sharing needles for drug use
• Being between the ages of 15 and 24

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 HIV Testing?

Medicare STD testing includes HIV. However, there are age restrictions. While Medicare is available to seniors ages 65 and over, some beneficiaries may qualify before this age restraint. Sadly, for seniors, Medicare only covers an annual HIV screening test for everyone aged between 15 and 65.

Medicare will, however, cover a yearly HIV screening for those outside of these age parameters, both younger and older, if they are at an increased risk of contracting the virus. If you’re pregnant, you can have up to three screenings during your pregnancy.

HIV testing is a preventive service. Those who qualify for benefits won’t pay anything for the test as long as their provider accepts Medicare assignment.

Does Medicare Cover Chlamydia Testing?

Those on Medicare enjoy coverage for Medicare STD 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 receive Medicare coverage for an annual screening.

Does Medicare Part D Cover STD and STI Medications?

Because Medicare Part D plans will usually cover antibiotics and antivirals, your coverage will likely provide benefits towards STD and STI medications. Depending on your plan, you may be responsible for a copay for your prescriptions.

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.

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 (ART) to treat HIV. Antiretroviral medications are one of six classes of drugs protected under Medicare.

Medicare Part D plans must cover all drugs in protected classes. This ensures that HIV patients will always have access to lifesaving treatments. But plans can vary depending on your location as formularies will differ. Be sure to speak with a licensed Medicare agent to understand the best coverage options for your healthcare needs.

Does Medicare Cover STD or STI Treatments?

Medicare covers STD and STI treatments when they are medically necessary. This includes doctor visits, tests, and other therapies for beneficiaries. Those with Medicare Part B will receive 80% coverage while paying the remaining 20% on their own. Medicare Supplement (Medigap) plans covers the balance of what Medicare pays towards your treatment.

Does Medicare Cover Online STD Testing?

While several companies offer STD testing kits that you can buy online, Medicare won’t cover them. Medicare covers STD testing, but it must be ordered by a doctor. The testing must also be conducted at a facility enrolled in Medicare to qualify for coverage.

When you purchase STD testing kits online, you obtain the sample needed for testing and then send it back to the company for evaluation. Therefore, you will not receive coverage.

How Often Will Medicare Cover STD Testing?

Medicare covers STD testing as a preventive service once a year for most people. Medicare-eligible individuals who are also pregnant can get a test for chlamydia and gonorrhea after learning they are pregnant and a repeat test later in your pregnancy. Pregnant people can also get up to three HIV tests during their pregnancy.

Medicare Advantage and STDs or STIs

If you’re on a Medicare Advantage plan, you can still get an annual STI screening at no cost. Medicare Advantage plans must offer the same benefits as 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 Medicare Part D prescription drug 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.

Healthcare needs vary among those on Medicare. For some, Medicare Advantage may be the best option. Speaking with a licensed Medicare agent can help you pinpoint which benefits best suit your needs.

How To Stay Protected With Medicare STD Testing and Treatments

If you want Medicare to cover STD testing, we can help you find the best coverage for your needs. Our highly trained agents know Medicare inside and out and are dedicated to finding the best options for you.

We’re here to answer your questions and guide you through the enrollment process, providing you with the best options for your healthcare. Call us at the number above to find comprehensive Medicare coverage. Or, fill out our online form to see your rates today!

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