Part B of Medicare covers various preventive care services, such as wellness checkups and screenings for various diseases. STD testing is included.
Sexually transmitted diseases are caused by sexually transmitted infections (STIs), which is why STD testing is sometimes also called STI Testing.
If you are at high risk for an STI, you can be tested once a year. As long as you meet the standards, Medicare will cover the entire cost of testing.
If you have original Medicare, your coverage will be through Part B or your Medicare Advantage plan if you have one.
When does Medicare cover STD testing?
You can get Medicare coverage for STD testing services, but you must meet Medicare's conditions. Depending on the test you require, Medicare has slightly varying restrictions.
If you require an HIV test, Medicare will pay for it if you meet the following criteria:
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You’re pregnant
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You’re between the ages of 15 and 65
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You’re over age 65 but at an increased risk
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You’re under age 15 but at an increased risk
During your pregnancy, Medicare will fund up to three prenatal tests. In all other circumstances, HIV testing will be covered once a year.
Other STD testing is covered by Medicare once a year if you are at high risk or during your pregnancy.
Some more STD testing covered by Medicare include screenings for:
What does Medicare consider an increased risk for an STI?
For a variety of reasons, Medicare may consider you to be at elevated risk for an STI. You can get screened if you've engaged in any of Medicare's "high-risk" sexual activities.
This includes if:
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You’ve had multiple sex partners.
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You’ve had sex without a condom or other barrier method.
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You’ve had sex under the influence of drugs or alcohol.
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You’ve had sex in exchange for money or drugs.
Medicare will also consider you at increased risk if:
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You had an STI in the past year.
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You live in a community that has a high prevalence of any STI.
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You’re a male who has had sex with another male and engaged in one of the practices above.
Furthermore, if you are a sexually active woman under the age of 24, Medicare considers you to be at high risk for chlamydia and gonorrhea.
Finally, if you use intravenous drugs, Medicare considers you to be at high risk for hepatitis B.
If any of these criteria apply to you, or if you have any other reason to believe you may have been exposed to an STI, consult your doctor. Your doctor can issue you an STI test order.
If your doctor prescribes the test and you are at a greater risk, Medicare will fund it.
Does Medicare cover STI testing for LBGTQIA people?
For the LGBTQIA community, Medicare provides STI tests.
As previously stated, Medicare will fund STI testing for any male who has had sex with another male, regardless of gender identification.
The Affordable Care Act (ACA) has also extended coverage and protections.
Some new safeguards that can aid in STI testing include:
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The gender specified on your Medicare card does not affect the covered services. This allows transgender people who have not legally altered their gender to receive proper care, such as STI testing.
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Medicare provides coverage for same-gender spouses. You can now qualify for Medicare based on your spouse's employment credits, regardless of whether your spouse is male or female.
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You have the right to be free of discrimination while seeking medical care. Medicare providers must give the same level of service to all patients. You can submit a complaint with Medicare if your provider does not comply.
How much does the average STI test cost?
STI testing can range from $0 to $300. The cost of an STI test is determined by several factors, including the procedure and where you go for testing. Because many providers provide sliding-scale fees for STI tests, your income may also be an issue.
When you use Medicare, you will not be charged for resting.
There is no copayment or coinsurance with Medicare for testing. Medicare will cover the entire cost of your test if a doctor orders it and you are eligible.