Medicare coverage of screening and counseling for sexually transmitted infections (STIs)
Section IV.m. Preventive Care Services
Question 22 of 24 (use "Last" or "Next" buttons to see more)
Medicare covers sexually transmitted infection (STI) screening lab tests for chlamydia, gonorrhea, syphilis and/ or hepatitis B. These screening lab tests will only be covered for people with Medicare who are pregnant and/or who have an increased risk for an STI. Medicare will also cover short counseling sessions to prevent you from contracting an STI if you are considered at increased risk.
You are considered at increased risk of contracting an STI if you:
Living in an area with a high rate of STIs, may also increase your risk for STIs.
STI screening costs
STI screening and counseling is free for people with Medicare who are considered high risk if you see a doctor who accepts assignment. This means your doctor should not charge you a copay, coinsurance or deductible for an STI screening or counseling. If you have a Medicare Advantage plan, you should pay nothing for these STI tests or counseling services if get them from in-network doctors or providers. If you see providers that are not in your plan’s network, charges will typically apply.
STI screening coverage rules
Medicare will cover STI screening lab tests if your primary care doctor refers you for these tests and you receive them from a Medicare approved lab. Your primary care doctor or other health care provider should determine whether you are at increased risk for an STI when they take your medical history, typically during an Annual Wellness Visit or during a prenatal visit.
Medicare coverage for STI tests depends on your situation and the type of test.
Chlamydia and gonorrhea
Medicare will cover screening lab tests for Chlamydia and gonorrhea:
Medicare will cover syphilis lab tests:
Medicare will cover a lab test screening for hepatitis B at your first prenatal visit, if you are pregnant, regardless of your risk or age and at the time of delivery if you show new or continuing risk factors for STIs.
Medicare also covers up to two individual 20 to 30 minute, face-to-face counseling sessions annually for sexually active teenagers and adults at increased risk for STIs. This counseling is meant to prevent STIs through education and advice about minimizing risky sexual behavior. Medicare will only cover these counseling sessions if they take place in a primary care setting such as a doctor’s office. Counseling conducted in an inpatient setting, such as a skilled nursing facility will not be covered as a preventive benefit.