What STD Treatments and Services does Medicare Cover?
This article was updated on: 09/15/2018
STD treatments aren’t just for people in their teens or 20s. Sexually transmitted diseases, or STDs, can affect the elderly as well as the young. STDs are also referred to as STIs (sexually transmitted infections).Anybody who is sexually active, regardless of age, is at risk of diseases such as syphilis, gonorrhea, chlamydia, genital herpes, hepatitis B, genital warts, and HIV, the virus that causes AIDS, according to the Centers for Disease Control and Prevention (CDC).
Modern medicine has made some progress in treatment of STDs, and prevention as well. According to the National Institute on Aging, the highly active anti-retroviral therapy (HAART) for HIV infection in the 1990s is one of modern medicine’s most dramatic success stories when it comes to STD treatments.
But news for seniors with STDs isn’t all good. Recent statistics from the CDC have shown that the number of new HIV infections is actually growing faster in people over 50. The CDC notes that in 2014, 40% of those people aged 55 and older who had AIDS were diagnosed late in the course of the infection. As a result of starting treatment late, these people may have suffered more immune system damage than might have occurred with early detection and treatment.
Medicare coverage of STD (SDI) treatments and screenings
If you’re seeking Medicare coverage for STD treatments, scroll down to the section on prescription drug coverage. According to the National institutes of Health, STD treatments generally include prescription drugs, such as antibiotics.
Prevention and screening may help you avoid having to get STD treatments. Medicare may cover screening for sexually transmitted diseases (STDs), also known as sexually transmitted infections (STIs), under Medicare Part B (medical insurance) as a preventive service benefit.
While it may not cover STD treatment, Medicare Part B may cover screening lab tests for chlamydia, gonorrhea, syphilis and/or hepatitis B. These screening lab tests may be covered if you are pregnant and/or who have an increased risk for an STD. Medicare will also cover short counseling sessions on STD prevention to those at risk.
The Centers for Disease Control and Prevention (CDC) recommends getting screened for an STD if you:
- Are aged 13-64
- Have had multiple sex partners
- Have a new sex partner
- Have a sex partner who’s infected with an STD
- Are a man who has had sex with men
- Are pregnant
- Use street drugs and share your equipment with anyone
STD screenings and behavioral counseling may be provided at no cost if your doctor accepts Medicare assignment and determines you are at an increased risk for contracting an STD. If you receive behavioral counseling, you must receive the counseling from a primary care practitioner in a primary care setting, such as a doctor’s office, or it might not be covered.
The type and frequency of STD screening Medicare might cover may depends upon your circumstances. Women who are at increased risk may be eligible for Medicare coverage for chlamydia and gonorrhea screenings annually and during prenatal care. Women and men at increased risk may be eligible for Medicare coverage for annual syphilis lab tests. Medicare may cover a lab test screening for hepatitis B if you are pregnant at your first prenatal visit regardless of your risk or age and at the time of delivery if you show new or continuing risk factors for STDs.
Medicare usually also covers HIV screenings once every 12 months for any Medicare beneficiary who asks for the test, or up to three times during pregnancy.
You may want to talk to your doctor about STD screenings and treatments during your next annual Medicare Wellness visit.
STD treatment and Medicare prescription drug coverage
Are you are enrolled in a stand-alone Medicare Part D Prescription Drug Plan or a Medicare Advantage Prescription Drug plan? Your plan might provide coverage for medications to treat STIs (STDs). As noted above, STD treatments often involve prescription medications.
While Medicare Prescription Drug Plans have formularies, or lists of covered drugs, medications used in the treatment of HIV (human immunodeficiency virus) are in a “protected class.” This means that Medicare plans offering prescription drug coverage must include “all or substantially all” drugs from this class in their formularies.
A plan’s formulary may change at any time. You will receive notice from your plan when necessary.
If you’d like more information about your Medicare coverage and plan options for prescription drugs that might be prescribed to treat STDs, I’m here to help answer your questions. To speak by phone or email, use the links below to set up a phone appointment or have me email information to you. To find plans right now, just click on the Compare Plans buttons on this page.