Does Medicare Cover STD Testing?
Medicare will cover free sexually transmitted disease screenings once a year if you’re pregnant or are at high risk for contracting an STD. Medicare also covers an annual HIV screening for anyone ages 15 to 65, as well as younger or older beneficiaries at an increased risk for HIV.
Medicare Coverage of STD Screenings
Medicare covers a variety of preventive care services, including screenings for sexually transmitted diseases. STDs are also known as sexually transmitted infections, or STIs.
Medicare will cover STI screenings once a year if you’re pregnant or at increased risk for an STI.
- Hepatitis B
Medicare also covers a free HIV screening each year for those who qualify.
- You’re age 15 to 65
- You’re younger than 15 or older than 65 and at an increased risk for HIV
- You’re pregnant
Pregnant women can receive STI and HIV testing more frequently than other Medicare beneficiaries because the presence of an STI during pregnancy can result in significant health complications for the mother and child.
For example, Medicare coverage includes up to three HIV screenings for pregnant beneficiaries. This includes when the woman first learns she is pregnant — during the third trimester and again during labor — if ordered by the woman’s doctor.
Medicare Coverage of High-Intensity Behavioral Counseling
In addition to STD screenings, Medicare also covers up to two 20-minute to 30-minute, face-to-face counseling sessions each year if you’re a sexually active adolescent or an adult at increased risk for STIs.
The U.S. Centers for Medicare & Medicaid Services defines high-intensity behavioral counseling as a program intended to promote sexual risk reduction or risk avoidance.
- Skills training
- Guidance on how to change sexual behavior
You must be referred for this service by your primary care doctor and the counseling must take place in a primary care setting.
How Medicare Determines If You’re at High-Risk for an STI or HIV
You can get free STD screenings if you’ve engaged in any activities that Medicare considers high-risk sexual behaviors.
- Multiple sex partners
- Using sexual protection inconsistently
- Having sex under the influence of alcohol or drugs
- Having sex in exchange for money or drugs
- Having an STI within the past year
- Men having sex with men
- IV drug use (for hepatitis B only)
Medicare considers all sexually active women 24 years old or younger at an increased risk for chlamydia and gonorrhea.
Anyone between the ages of 15 and 65 can receive an HIV screening.
If you are younger or older, you must be considered at an increased risk of HIV to receive this Medicare-covered service.
- Men who have sex with men.
- Anyone having unprotected vaginal or anal intercourse.
- Past or present injection drug users.
- Anyone who exchanges sex for money or drugs, or has sex partners who do.
- Anyone whose past or present sex partners were HIV positive, bisexual or injection drug users.
- Beneficiaries with new sexual partners.
Your primary care provider will determine if you engage in any high or increased risk sexual behavior by assessing your sexual history.
This information is a standard part of most people’s general medical history. It’s often collected during your annual wellness visit or prenatal visit.
Cost of STD Testing with Medicare
You will owe nothing for these annual screenings so long as you meet eligibility requirements.
In addition to meeting the criteria, your STI lab tests must be ordered by a primary care doctor and performed by an eligible Medicare provider.
Medicare Advantage plans, which are administered by private insurers who contract with the federal government, also cover annual STI and HIV screenings for those who qualify.
4 Cited Research Articles
- Centers for Medicare & Medicaid Services. (n.d.). Decision Memo for Screening for the Human Immunodeficiency Virus (HIV) Infection (CAG-00409R). Retrieved from https://www.cms.gov/medicare-coverage-database/view/ncacal-decision-memo.aspx?proposed=N&NCAId=276
- Centers for Medicare & Medicaid Services. (n.d.). National Coverage Determination (NCD) for Screening for Sexually Transmitted Infections (STIs) and High-Intensity Behavioral Counseling (HIBC) to Prevent STIs (210.10). Retrieved from https://www.cms.gov/medicare-coverage-database/view/ncd.aspx?NCDId=352&ncdver=1&TAId=41&CoverageSelection=Both&NCSelection=NCA%7CCAL%7CNCD%7CMEDCAC%7CTA%7CMCD&ArticleType=Ed%7CKey%7CSAD%7CFAQ&PolicyType=Final&KeyWord=inpatient+rehabilitation&KeyWordLookUp=Doc&KeyWordSearchType=And&kq=true&bc=IAAAADgAAAAA&
- Medicare.gov. (n.d.). HIV screenings. Retrieved from https://www.medicare.gov/coverage/hiv-screenings
- Medicare.gov. (n.d.). Sexually transmitted infection screenings & counseling. Retrieved from https://www.medicare.gov/coverage/sexually-transmitted-infection-screenings-counseling