Sexually transmitted infections (STIs) are infections transmitted through sexual contact, such as gonorrhea or syphilis. Screening and counseling may help identify, manage, and treat STIs.
Medicare Part B covers screening tests for chlamydia, gonorrhea, syphilis, and/ or hepatitis B if you are:
- At high or increased risk of contracting an STI
- Or, pregnant
STI screenings are covered annually if you receive a referral from your primary care provider (PCP) or at certain times during pregnancy. Your PCP should determine if you are at high or increased risk for STIs while taking your medical history, typically during an Annual Wellness Visit or prenatal visit.
Medicare also covers up to two face-to-face counseling sessions for sexually active adolescents and adults at increased risk for STIs, when they receive a referral from their PCP. These sessions may help prevent STIs by providing education on how to minimize risky sexual behavior. STI counseling should be provided in a primary care setting, such as a doctor’s office.
Note: If you receive STI counseling in an inpatient setting, such as a skilled nursing facility (SNF), different costs and coverage rules may apply. Medicare does not cover inpatient STI counseling as a preventive service.
Chlamydia and gonorrhea
Medicare covers screening tests for chlamydia and gonorrhea:
- Annually, if you are a woman at increased risk
- If you are pregnant and are 24 years old or younger (and during your third trimester of pregnancy if you engaged in high-risk sexual behavior after your first test)
- If you are pregnant and are at increased risk for an STI (and during your third trimester of pregnancy if you engaged in high-risk sexual behavior after your first test)
Medicare covers syphilis tests:
- Annually, if you are 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)
Medicare covers a test 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.
If you qualify, Original Medicare covers STI screenings at 100% of the Medicare-approved amount when you receive the service from a participating provider. This means you pay nothing (no deductible or coinsurance). Medicare Advantage Plans are required to cover STI screenings without applying deductibles, copayments, or coinsurance when you see an in-network provider and meet Medicare’s eligibility requirements for the service.
During the course of your screening, your provider may discover and need to investigate or treat a new or existing problem. This additional care is considered diagnostic, meaning your provider is treating you because of certain symptoms or risk factors. Medicare may bill you for any diagnostic care you receive during a preventive visit.