Medicare coverage of screening and counseling for sexually transmitted infections (STIs)

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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:

  • Have had multiple sex partners
  • Use condoms inconsistently
  • Have sex under the influence of alcohol or drugs
  • Have sex in exchange for money or drugs
  • Are a woman who is 24 years old or younger and sexually active (for chlamydia and gonorrhea only)
  • Have had an STI within the past year
  • Have engaged in IV drug use (for hepatitis B only)
  • Are a man who has sex with men and engages in high risk sexual behavior, regardless of your age

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:

  • On an yearly basis if you are a woman at increased risk for an STI
  • If you are pregnant and are 24 years old or younger (and during your third trimester of pregnancy if you had risky sexual behavior after your first test)
  • If you are pregnant ,regardless of your risk or age and are at increased risk for an STI (and during your third trimester of pregnancy if you had risky sexual behavior after your first test)

Syphilis

Medicare will cover syphilis lab tests:

  • Every year if you are a man or a woman who is at risk for STIs
  • If you are pregnant, regardless of your risk or age, (and during your third trimester of pregnancy if you engaged in high risk sexual behavior after your first test) 

Hepatitis B

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.

STI counseling

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.


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