In many cultures, there is a stigma associated with having a sexually transmitted infection (STI), but it's important to understand that STIs are highly prevalent. Medicare can play a significant role in addressing this issue by covering screenings and, if necessary, providing treatment. STIs are common health conditions, and getting tested and treated is a responsible and essential aspect of maintaining one's sexual health. Medicare can help individuals access the necessary healthcare services to manage their sexual health effectively.
Add a blog postDoes Medicare Cover STIs?
It's essential to recognize that sexually transmitted infections (STIs) are quite common, with one in five Americans having an STI of some kind, according to the Centers for Disease Control and Prevention (CDC). These infections encompass a broad range, from herpes and cold sores to HIV and AIDS. The estimated lifetime medical costs of STIs acquired in 2018 were substantial, nearing $16 billion. STIs are not limited to specific age groups, as the rate of STIs among seniors in the United States has more than doubled over the past decade, reaching historic levels. This issue affects people of all ages and backgrounds.
Detecting and managing STIs is crucial for preventing their spread and seeking treatment. However, the costs of treating STIs can add up. While individuals may not bear the entire $16 billion cost, having coverage to help with these expenses is valuable. Depending on the type of STI, your health circumstances, or your age, Medicare may offer coverage. So, the question is: Does Medicare cover screenings and treatment for STIs? Please note that in this article, we'll use the term STI, although some may be more familiar with the phrase sexually transmitted disease (STD). These terms are generally interchangeable, but STI is more accurate.
Let's begin with some good news. Medicare Part B provides coverage for outpatient screenings for certain sexually transmitted infections (STIs), such as chlamydia, gonorrhea, syphilis, and hepatitis B, on an annual basis. We've previously discussed Medicare Part B's coverage of hepatitis, including hepatitis B, and the related screenings and vaccines. For the other specified STIs, Medicare will cover one screening per year or at specific intervals if you are pregnant. You qualify for this coverage if you are pregnant or if you are at an increased risk of contracting an STI. In either case, your doctor must accept Medicare assignment and order the test. If you meet the criteria for coverage, Medicare will handle the costs of the screenings, meaning you won't have any out-of-pocket expenses.
Medicare also offers another preventive service called high-intensity behavioral counseling. To be eligible for this service, you must be a sexually active adolescent or an adult who is at an increased risk of contracting STIs. Medicare covers two individual counseling sessions, each lasting about 20 to 30 minutes and conducted face-to-face. These sessions typically provide education on sexual risk reduction, strategies to avoid STIs, and guidance on adopting healthier sexual behaviors.
What Counts as “Increased Risk”
To clarify the criteria for being at an increased risk, it's important to understand that the national coverage determination (NCD) for STI screening and counseling provides a definition, but the final determination is made by your doctor. The NCD outlines specific qualifiers for each of the discussed infections, as well as what is considered an increased or high risk. Here are the general factors that can classify someone as at an increased risk:
- Multiple sexual partners
- Inconsistent use of barrier protection, like condoms
- Engaging in sexual activity under the influence of drugs or alcohol
- Exchanging sex for money or drugs
- Having had an STI within the past year
- Intravenous (IV) drug use
- Men who have sex with men and engage in high-risk sexual behavior
For the four infections mentioned in the NCD—chlamydia, gonorrhea, syphilis, and hepatitis B—pregnancy is a qualifying circumstance for screenings. This applies when pregnancy is known and during the third trimester, especially for pregnant individuals considered at an increased risk and under the age of 24 (particularly for chlamydia and gonorrhea). So, if you are pregnant or meet any of the other increased risk criteria, you may be eligible for Medicare-covered screenings and counseling sessions. However, it's always best to consult with your doctor for personalized guidance on whether you qualify.
What About Medications?
Treatment for sexually transmitted infections (STIs) typically involves antibiotics and antiviral drugs. Antiviral drugs are primarily used to manage conditions like HIV and herpes, helping suppress symptoms and control the diseases. It's important to note that antiviral drugs do not cure these conditions. We'll provide more specific information on HIV treatment in another article. On the other hand, antibiotics are more commonly used to treat infections like chlamydia, gonorrhea, and syphilis.
If your doctor prescribes antibiotics or antiviral drugs to treat an STI, your Medicare Part D plan or a Medicare Advantage plan with prescription drug coverage may provide coverage for these medications. Since these plans are offered by private companies, the exact cost you might owe and coverage details can vary. However, there's a good chance that your plan will offer some form of coverage for these treatments if they are prescribed. If you're concerned about coverage for STI treatment, it's advisable to review your plan's details carefully to ensure it meets your needs. You can also explore your options using the Medicareful Plan Finder and consult with a licensed insurance agent to find the best plan for you.
Sexually transmitted infections (STIs) are quite common in the United States, and if you're sexually active and at an increased risk, it's essential to stay informed about your STI status. This can involve getting regular screenings, seeking counseling services, and practicing safe sex to protect yourself and your sexual partners.
It's important to remember that your health is unique, and what works for one person may not work for another. The information in these articles is meant to provide general guidance but should not replace advice from a healthcare professional. If you're considering significant lifestyle or dietary changes, it's a good idea to consult with your primary care physician or a nutritionist who can provide guidance tailored to your specific health needs. Your doctor is the best person to understand your unique health circumstances.