Does Medicare provide cover for STD testing? Cost, follow-up, and more - Medical News Today

Posted: 29 Jan 2021 04:03 AM PST

Medicare provides coverage for various healthcare screenings and tests, including those for sexually transmitted diseases (STDs), also known as sexually transmitted infections (STIs).

People commonly use the terms STD and STI to describe health conditions that transmit between individuals through sexual activity.

As some sexually transmitted health conditions often do not produce any symptoms, STI is becoming the preferred term. However, Medicare does not distinguish between the two terms regarding coverage.

Medicare covers STI screenings that may include:

blood tests
urine tests
genital swabs

The type of test depends on what the healthcare professional is investigating.

Medicare sets guidelines for coverage, and a person may have some additional out-of-pocket expenses.

We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:

Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.

Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.

Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.

The different parts of Medicare provide coverage in certain situations.

Medicare Part A

Part A covers inpatient hospital costs. Usually, Part A does not cover STI screening, but if a person is admitted to a hospital and receives the test as part of their inpatient care, Medicare will cover the costs.

Medicare Part B

Part B provides coverage for outpatient services, such as preventive testing and screenings, including STI testing.

Medicare Advantage (Part C)

Part C, also known as Medicare Advantage, is the alternative to original Medicare.

Private insurance companies administer Medicare Advantage plans. While specific coverage may vary among plan providers, Medicare requires that all policies have at least the same coverage as parts A and B.

This requirement means that Medicare Advantage plan benefits include STI testing.

Medicare Part D

Part D prescription drug plans do not cover STI testing, but they usually cover any medically necessary medication that a doctor prescribes to treat an STI.

A person does not pay anything for STI testing if they have either a Part B or Medicare Advantage plan, as long as they meet Medicare's eligibility requirements.

Medicare waives deductibles and copayments for these preventive services.

Medicare covers tests for the following STIs:

chlamydia
gonorrhea
syphilis
hepatitis B

Medicare also covers the cost of an HIV test once a year for people aged 15–65 years and those outside of this age range who have an increased risk of HIV.

Also, during pregnancy, a person may have three HIV screenings.

In most cases, Medicare Part B provides yearly coverage for the costs of STI testing when an individual who is pregnant or at high risk of contracting an STI receives a referral from their healthcare provider.

High risk

A person's healthcare provider will help determine whether they are at an increased risk of contracting an STI.

The Preventive Services Task Force note several factors that may increase a person's risk. These include:

having multiple or anonymous sexual partners
having sex under the influence of drugs or alcohol
inconsistent use of barrier protection, such as condoms, during sex
IV drug use (for hepatitis B)
high prevalence of STIs in a community
the person having had an STI within the last year

Pregnancy

Medicare also covers STI testing at certain times during pregnancy.

For Part B to cover the costs, a doctor must provide a referral, and a Medicare-certified healthcare professional must administer the test.

Usually, people need to wait a few days for STI test results. Medicare then covers treatment following a positive test. The type of treatment necessary may vary depending on the specific condition.

For example, chlamydia, syphilis, and gonorrhea develop due to bacterial infections, which require treatment with antibiotics. When viruses cause STIs, such as herpes, a doctor may prescribe antiviral medications. Medicare covers the cost of both of these types of drugs.

Medicare Part D plans generally cover the medications that doctors use to treat STIs, but some out-of-pocket costs may apply.

If an infection or disease becomes severe enough to require inpatient care, Medicare Part A will cover the eligible costs.

An STI may transmit from person to person with the exchange of bodily fluids during sex.

As individual sex practices and risks vary, the recommendations for the frequency of testing also vary. An individual should talk with their doctor to determine how often they should consider testing.

In general, the Centers for Disease Control and Prevention (CDC) recommend STI testing as follows:

People aged between 13 and 64 years: Recommendations include testing at least once a year for HIV.
Females younger than 25 years who are sexually active: The CDC recommend yearly tests for gonorrhea and chlamydia.
Females 25 years and older with risk factors: Recommendations include a test yearly for chlamydia and gonorrhea.
During pregnancy: Recommendations include HIV, syphilis, and hepatitis B tests in early pregnancy. The CDC also recommend gonorrhea and chlamydia testing for those at high risk.
Sexually active bisexual or gay males: Recommendations include testing once a year for gonorrhea, chlamydia, and syphilis.
People who share drug equipment or engage in unprotected sex: The CDC recommend HIV testing yearly.

Primarily, Medicare Part B covers STI testing. Prevention, early diagnosis, and treatment for STIs can help prevent further health complications.

Depending on a person's circumstances, age, and risk factors, their doctor may recommend a specific frequency of STI testing.

Usually, a person pays nothing for an STI test, with Medicare waiving the associated deductibles and copayments.

The information on this website may assist you in making personal decisions about insurance, but it is not intended to provide advice regarding the purchase or use of any insurance or insurance products. Healthline Media does not transact the business of insurance in any manner and is not licensed as an insurance company or producer in any U.S. jurisdiction. Healthline Media does not recommend or endorse any third parties that may transact the business of insurance.

Augusta HIV and STD testing decreases during pandemic, but numbers likely remain high - The Augusta Chronicle

Posted: 29 Jan 2021 03:00 AM PST

Jozsef Papp | Augusta Chronicle

Concern remains among health care officials about a decrease in HIV and STD testing due to the COVID-19 pandemic.

Raven Wells, community outreach coordinator for the Ryan White Program, said they've seen a decrease in HIV testing in the Augusta area, which concerns her because HIV can be considered a pandemic on its own.

"We don't necessarily have it under control as much as we would like to," Wells said.

Wells said health care providers wanted to show a united front and followed Centers for Disease Control and Prevention guidelines to stay home, so the program didn't offer HIV testing at the beginning of the pandemic.

Since guidelines have changed, Wells said they are trying to offer free self-testing kits.

With a decrease in testing, the number of HIV and STD cases might appear to be lower for 2020, but Wells said it is realistic that numbers are still increasing, since people are probably still having sex. The Georgia Department of Public Health, which keeps track of HIV and STD data for the state, does not have 2020 numbers ready and is still working to confirm 2019 STD numbers.

According to DPH data, there were 3,746 STD cases in Richmond County in 2019, down from 3,874 in 2018, but up from 3,605 in 2017. The most common STD in Richmond County was chlamydia with 2,574 cases, followed by gonorrhea with 985. Most cases were among Black people with 2,946 STD cases and among 20- to 24-year-olds with 1,191 cases in 2019.

Columbia County had 696 STD cases in 2019, up from 617 in 2018 and 620 in 2017. Similar to Richmond County, chlamydia and gonorrhea were the most common STDs.

Georgia DPH infectious disease section director Michelle L. Allen said the department has not reduced the number of services it provides during the pandemic but they did see a decline in HIV testing. STD testing for gonorrhea and chlamydia has also decreased, but Allen cited slower production of testing kits due to the manufacturer having COVID-19 related issues.

"COVID-19 expanded our responsibilities, but it did not reduce any of our core or essential functions. STDs and HIV testing has gone on during the pandemic. While, in addition to doing that, we were also able to address adding COVID testing and, now, vaccine distribution to our routine," she said. "We saw a decline in HIV testing. The decline is actually very consistent with what we've seen nationwide."

Preliminary statewide data shows STD cases increased by 4,955 in 2019 with 94,954 total cases. Richmond County had the sixth-most STD cases in the state, behind Fulton, DeKalb, Gwinnett, Cobb and Clayton counties.

Richmond County saw 103 new HIV diagnoses in 2018, with a total of 1,593 people in the county living with HIV. Columbia County had 16 cases with 200 HIV-positive people living in the county. In terms of HIV cases, Georgia DPH only has data up to 2018 due to 2019 numbers not being finalized.

The state had 2,600 HIV diagnoses in 2018 bringing the total of people living in the state with HIV to 60,346, according to DPH data. The majority of the 2018 cases were among Blacks with 1,809, most of the transmission was through male-to-male sexual contact with 1,684 and most of the HIV diagnoses were in the 20-29 age group with 1,040.

According to DPH, Georgia ranked fifth in the nation for number of new HIV diagnoses and persons living with HIV infection. Georgia was first in the rate of HIV diagnosis among adults and adolescents and fourth in the rate of people living with HIV. Based on the CDC 2018 HIV Surveillance Report, the Augusta-metro area has the sixth highest sexually transmitted disease rate in the country.

Allen said they are offering at-home testing options for HIV testing and are working with health districts across the state to soon offer at-home STD testing. She hopes at-home testing can help deal with the stigma around STD and HIV testing.

"Stigma is an issue for STD and HIV above and beyond the COVID pandemic. Stigma occurs for many reasons," she said. "We want to provide opportunities to share the information to help reduce stigma and we want to share the information to let people know how they can access the services that they may need that we offer."

Wells said people should still be practicing safe sex practices, like condom-use, during the pandemic, or even limited sexual activity while the pandemic is ongoing.

"You really want to know people's status. Now, because of COVID, it's easier to access the HIV test, at least in our area," she said.

At-home HIV test pickup locations

Walgreens Community Pharmacy – 8:30 a.m.-1:30 p.m. and 2-5 p.m. weekdays; closed Saturdays and Sundays

Harrisburg Family Healthcare – 10 a.m.-2 p.m. Monday; 10 a.m.-4:30 p.m. Tuesday-Wednesday

The tests are free and can be done in 20 minutes at home.

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