Sexually transmitted infections (STI), which are also called sexually transmitted diseases (STDs), refers to infections that are transmitted from person to person through sexual contact. Examples of sexually transmitted infections include diseases such as syphilis, gonorrhea, herpes genitalia, hepatitis B, chlamydia and trichomoniasis. Screening for an STI can lead to early diagnosis and treatment, which can help to prevent more serious infections and the development of later complications. Read on to learn more about when Medicare will cover Sexually Transmitted Infection Screening and Counseling.
When Will Medicare Cover Sexually Transmitted Infection (STI) Screening and Counseling?
Medicare Part B will cover Sexually Transmitted Infection (STI) Screening and Counseling for syphilis, gonorrhea, chlamydia, and hepatitis B if the Medicare enrollee is either pregnant or is deemed by their personal physician to be at an increased risk for STIs.
Screenings fir STIs can be conducted each year at an annual wellness visit if you are given a referral from your primary care physician because he has determined that you are at a high risk of contracting an STI.
Medicare will also pay for from one to two counseling sessions for seniors or adolescents, who are at high risk of contracting a sexually transmitted infection. This can only be accomplished when the patient’s primary care physician gives a referral in response to deeming the patient’s sexual behavior risky. These counseling sessions must, according to Medicare rules, be conducted in a primary care physician’s office or clinic.
It is important to note that Medicare will not cover STI screening or counseling if the patient is currently an inpatient in a skilled nursing care facility.
When Will Medicare Cover Screening Tests for Chlamydia and Gonorrhea?
Medicare will cover screening tests for chlamydia under the following circumstances:
- The patient is assigned female at birth (AFAB) and deemed to be at an increased risk for contracting a STI.
- The patient is AFAB, non-pregnant, 24 years of age or younger, and is sexually active.
- The patient is currently pregnant and under the age of 24.
- The patient is currently pregnant, over the age of 24, and at an increased risk of contracting a STI.
Medicare will cover screening tests for Gonorrhea under the following circumstances:
- The patient is a sexually active and AFAB—Including those who are pregnant—If they are at an increased risk of contracting a STI.
When Will Medicare Cover Screening Tests for Syphilis?
Medicare will cover screening tests for syphilis on a yearly basis if the beneficiary has an elevated risk of contracting sexually transmitted diseases. Medicare also covers screening tests for syphilis for any beneficiary who is a pregnant no matter their age or risk level for STIs.
When will Medicare Cover Screening Tests for Hepatitis B?
Medicare will fully cover and pay for a screening test for Hepatitis B during a first prenatal visit regardless of age or risk level for STIs. Medicare will also cover the cost of testing for Hepatitis B at the time of delivery if a patient shows any signs of previous or new STIs.
What is the Cost to You of Sexually Transmitted Infection Screening?
Medicare will pay all the costs of Sexually Transmitted Infection screening if a beneficiary obtains that screening from a provider approved by Medicare that accepts the Medicare approved amount for payment. In this case, the beneficiary is not responsible for paying deductibles, copays, or coinsurance, for their STI screening.
Does Medicare Pay for the diagnosis or Treatment of Any New or Existing Problems Discovered During Sexually Transmitted Infection (STI) Screening?
If, while undergoing STI screening, other new or pre-existing medical problems or conditions are uncovered, and there is a need for a primary care physician to either investigate, diagnose, or treat these other problems, this care is not considered to be preventative by Medicare. Any care for the newly discovered condition or conditions are separate from the screening for the STI, and the beneficiary will be billed under the category of new diagnostic procedures rather than preventative screening and counseling.
Because screening for STIs is preventative care and the treatment of new or pre-existing medical problems (that are not the STIs being screened for) are not preventative care, beneficiaries can be billed by Medicare for any additional tests or diagnostic procedures unrelated to the initial screening. Such follow-up tests and procedures include blood cultures, metabolic blood tests, fasting blood sugar tests and HgbA1C tests, lipid blood profiles, thyroid blood tests, ultrasound examinations, urinalysis or urine cultures, X-Rays, radionuclide scans, CT scans, PET scans, MRIs or other radiologic diagnostic tests. The same Medicare rules apply to any other tests deemed appropriate by a physician to fully diagnose and/or treat medical conditions.