Medicare Coverage of Syphilis Treatment
Last Updated : 10/21/20194 min read
Syphilis is a sexual transmitted disease (STD) that you can get from direct contact with a syphilis sore during vaginal, anal, or oral sex, reports the Centers for Disease Control and Prevention (CDC). An untreated syphilis infection can span decades and eventually cause serious health problems.
There are several ways that Medicare may cover syphilis treatment. Medicare may cover testing for a syphilis infection and also may cover prescription medication for syphilis treatment. If your syphilis infection requires outpatient treatment or even inpatient hospitalization, Medicare may cover that as well.
What are the symptoms of syphilis?
According to the CDC, you can have syphilis and not know it. A syphilis infection has four stages.
- Primary syphilis manifests as sores at the site of the infection, usually the genitals, anus, or mouth. These sores are often painless.
- Secondary syphilis manifests as a rash, swollen lymph nodes, and a fever. Sometimes these symptoms are mild and can go unnoticed.
- Latent stage syphilis has no symptoms (but the syphilis infection can still be detected in a blood test).
- Tertiary syphilis can affect important body systems, such as the heart and blood vessels, brain and nervous system. Tertiary syphilis can cause aneurysms, central nervous system disorders, and bone, skin and liver tumors, according to the National Institute of Health (NIH). This stage occurs 10-30 years after the initial infection and serious organ damage can result in death.
Can syphilis be prevented?
One way to avoid syphilis, according to the Centers for Disease Control and Prevention (CDC), is to use a latex condom every time you have sexual contact. Condoms may prevent contact with a syphilis sore, but contact with sores not covered by a condom can still transmit syphilis. Another way to reduce your risk of syphilis is to be in a long-term mutually monogamous relationship with someone who has tested negative for syphilis. However, according to the CDC, the only way to completely avoid STDs like syphilis is to not have vaginal, anal, or oral sex.
What are the methods of syphilis treatment?
According to the CDC, syphilis is easy to treat and cure. The first step to syphilis treatment may be to get tested for it. You can get tested even if you don’t notice any symptoms because it’s possible to have syphilis and pass it on to others without knowing it. Most of the time a syphilis test is performed through a blood draw. Sometimes a doctor may test for syphilis by collecting fluid from a syphilis sore.
Since syphilis is caused by a bacterial infection, antibiotics can be effective syphilis treatment, according to the CDC. In fact, just one shot of penicillin may cure a person who has had syphilis for less than a year. If a person has had syphilis for longer than a year, it may require more doses of penicillin to treat them. According to the National Institute of Health (NIH) doxycycline may be used to treat people who are allergic to penicillin.
How does Medicare cover syphilis?
Medicare may cover all the stages of syphilis treatment. Medicare may cover a syphilis test once every 12 months or certain times during pregnancy. People with Part B who are pregnant are eligible as well as certain people with Part B who are at an increased risk for an STD when the syphilis tests are ordered by a primary care practitioner. If your primary care practitioner accepts assignment you generally pay nothing for syphilis tests under Medicare.
Original Medicare (Part A and Part B) doesn’t cover most prescription drugs, but you may be able to get Medicare Part D coverage for the antibiotics used for syphilis treatment. Part D prescription drug coverage may be available through a Medicare Advantage Prescription Drug Plan or a stand-alone Medicare Part D Prescription Drug Plan. Whether or not your plan covers penicillin or doxycycline depends on the plan’s formulary, or list of covered prescription drugs. The formulary may change from time to time but the plan must let you know of the changes when necessary.
If your syphilis infection progresses to tertiary syphilis you may need outpatient care or even inpatient syphilis treatment. Medicare Part B generally covers certain outpatient services usually at 80% after you pay your deductible. Medicare Part A covers inpatient hospital care.
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