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Does Medicare Cover STD Testing?

Just the Essentials...

  • Any sexually active person, regardless of age, is at some risk for sexually transmitted disease.

  • Original Medicare covers testing and counseling for several of the most common STDs under certain conditions. These tests are completely anonymous.

  • Contraceptives, birth control devices, and medications like PrEP are available under Medicare Part D and Medicare advantage plans.

  • Medicare does not discriminate based on gender identity or sexuality. Your doctor will help you determine what services you need.

Is STD Testing Really Necessary for Seniors?

Illustrative image of a senior couple embracing.

Contrary to popular belief, sexual activity does not automatically cease after a certain age. Many adults remain sexually active well into their senior years, and the lifestyle changes brought about by retirement and children leaving home can lead some seniors to engage in more adventurous, experimental behavior. It can be a liberating experience, increasing self-esteem and satisfaction with life.  

Unfortunately, sexual activity in older adults comes with the risk of sexually transmitted disease (STD), just as it does at any age. Moreover, the lifestyle changes that come with aging and retirement can lead to an increased risk of infection if one does not practice safe sex.

The Risk of STDs in Seniors is on the Rise.

STDs are commonly considered a young person’s problem, which is partially true: the high school and college-aged demographics have the highest infection rates. However, recent societal changes have caused the incidence of sexually transmitted diseases in older adults to rise at an alarming rate. There are several reasons for this, including increased access to erectile dysfunction treatment, rising divorce rates, the spread of online dating, and a generally relaxed attitude toward sex. 

Seniors who have recently ended long-term partnerships and those who have recently begun an open relationship may be used to sex without a condom. While this is generally considered a safe practice when engaging in intercourse with a committed partner while using other forms of birth control, such as an IUD, vasectomy, or birth control medication, it can be risky when engaging with new or multiple partners.

Does Medicare pay for STD testing?

Medicare Part B covers STD testing for chlamydia, gonorrhea, syphilis, and Hepatitis B. To qualify, you must be at increased risk of infection. This means that you must meet one of the following criteria:

  • You’ve had multiple partners

  • You’ve had sex without a condom or similar barrier

  • You’ve had sex while intoxicated by drugs or alcohol

  • You’ve had sex in exchange for money or drugs

  • You have had an STD in the past year

  • You live in an area with a high prevalence of STDs

  • You are a male who has had sex with another male and engaged in any of the above practices

  • You are a sexually active woman under the age of 24 (chlamydia and gonorrhea only)

  • You use intravenous drugs (hepatitis B only)

  • You are currently pregnant

Be aware: it is illegal for your doctor to disclose any information about your health and medical history to third parties without your consent, including family members or the authorities. The information used to determine if you qualify for Medicare STD testing and the said test results are 100 percent confidential. Do not be afraid to disclose medical information to a medical professional because of embarrassment or legal consequences.

Medicare also covers two high-intensity, face-to-face behavior counseling sessions for sexually active adults at elevated risk. Ask your doctor for more information if you are interested in undergoing one of these 20 to 30-minute sessions.

illustrative image of wrapped condoms

HIV Testing Under Medicare

Human Immunodeficiency Virus (HIV) is the virus that causes AIDS (Acquired Immunodeficiency Syndrome). Like all viruses, HIV infects cells to replicate. What makes it so dangerous is the specific cells it chooses to infect — those that make up your immune system. 

If left untreated, HIV weakens your immune system to the point where you cannot defend yourself from seemingly trivial infections. In the past, HIV was practically a death sentence, but while there is no cure, recent advances in medicine can halt the progression of the disease and even prevent infection in the first place.

Because of the severity of HIV when left untreated, Medicare will cover HIV testing for all beneficiaries between the ages of 15 to 65 and those who meet the above criteria. You may also be eligible for testing up to three times during pregnancy.

If you are at elevated risk for HIV, you may be prescribed a pre-exposure prophylactic or PrEP. This pill can almost entirely remove your risk of infection, particularly when used in conjunction with condoms and safe sex practices. PrEP is available at zero, or low cost through Medicare Part D and Medicare Advantage plans that cover prescription drugs. Many local programs are in place specifically to increase access to the life-saving medication. 

I’m LGBTQA+, are my STD tests covered by Medicare?

Medicare will cover your health services regardless of your sexuality or gender identity. As mentioned above, Medicare will cover STD tests for men who have sex with men. Medicare does not consider the gender on your Medicare card when determining eligibility for services. Instead, your doctor will determine whether or not you qualify based on your sexual and medical history.

Will Medicare pay for contraceptives or STD medication?

Original Medicare does not cover contraceptives, nor does it cover prescription medication.  Medicare will also not cover vasectomies or tubal ligation.

You can get coverage for prescription medications and certain contraceptives under Medicare Part D, including PrEP, birth control medication, and intrauterine devices (IUD). Procedures such as vasectomies and over-the-counter contraceptives like condoms and diaphragms may be covered under Medicare Advantage. Check your specific plan’s benefits for more details.

If you are looking for insurance to support your sexual health, Medicare Advantage may be the right option for you. Contact a licensed insurance agent at (800) 950-0608 to compare your options.

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