Many people wonder if their insurance will cover the costs of STD screening and prevention. In some cases, the answer is yes, but it depends on the type of insurance you have.
Medicare Part B covers some STD screenings, including HIV testing, syphilis testing, and chlamydia testing, but it may not cover all types of screenings or treatments.
Some private insurance plans may also cover STD screenings and treatments, but the specifics can vary greatly depending on the plan.
Insurance coverage for STD screenings and prevention can be a complex issue, but it's essential to know what's covered and what's not to avoid unexpected medical bills.
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Insurance Coverage
Most health insurance plans cover STD testing, but the specifics can vary depending on your age, gender, risk factors, and other factors. If you're under 65, most plans must cover preventive health care, including wellness exams and STD testing, with no copay or out-of-pocket costs.
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Under the ACA, all insurance plans must cover HIV testing for people between 15 and 65, and for others if they're at higher risk. You can talk with your nurse or doctor or call your health insurance provider to find out what STD tests are covered for you.
Most plans cover at least one wellness visit per year, which may include services like pelvic exams, Pap tests, and STD testing. Other preventive care services, like vaccines and cholesterol screenings, are also covered.
If you don't have insurance, you can get free or low-cost STD testing from your local Planned Parenthood health center, family planning clinics, or community health care centers. Some states also extend access to STI services through limited-scope Medicaid family planning programs.
Here are some STI-related preventive care benefits that plans must cover without cost-sharing:
Medicare Part B covers sexually transmitted infection screenings and behavioral counseling sessions, and you pay nothing if your provider accepts assignment.
STI Prevention and Treatment
STIs are preventable, and there are treatments to cure many of them.
The CDC estimates that in 2008, the annual direct medical costs in the US associated with STIs (including HIV) were nearly $16 billion.
Access to prevention, screening, testing, and treatment services for STIs is facilitated by private insurance, public coverage such as Medicaid and Medicare, as well as publicly-supported health programs.
Untreated STIs can result in serious health concerns, including pelvic inflammatory disease (PID) in women and infertility.
The HPV vaccine protects against nine strains of the virus, including several that are associated with cancer.
Pregnant women with an untreated STI face increased risk of complications as do their infants.
Exposure to an STI during pregnancy can result in preterm labor, low birth weight, premature rupture of membranes, and transmission to the infant during delivery.
So long as a mother with HIV is engaged in consistent antiretroviral (ARV) treatment, it would be highly unlikely to transmit HIV to a baby.
Up to 40% of babies born to women with untreated syphilis may be stillborn or die from the infection.
Late or limited prenatal care has been associated with congenital syphilis, which is preventable in most cases if women are screened for syphilis and treated early during prenatal care.
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Testing and Costs
Most health insurance plans cover STD testing, but the specifics can vary depending on your age, gender, risk factors, and pregnancy status.
Testing for HIV is covered for everyone ages 15 to 65, and other STD tests may be covered as well.
Lab testing fees range from $8 to $150, and at-home tests cost between $35 and $175 per test.
If you need STD testing or treatment not covered by your health insurance, or if you don't have health insurance, local Planned Parenthood health centers and community health care centers may offer free or low-cost testing.
You can check with your health insurance provider or a nurse or doctor to find out what STD tests are covered for you and how much they'll cost if you have to pay out of pocket.
Some clinics, usually community or nonprofit clinics, offer free or low-cost testing, and labs, clinics, and at-home testing companies may accept insurance to cover or lower your cost of testing.
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If you're eligible for Medicare Part B, sexually transmitted infection screenings and behavioral counseling sessions are covered, and you won't pay anything if your provider accepts assignment.
Here's a rough estimate of the costs of STD testing:
Keep in mind that these costs may not apply to you, especially if you have health insurance that covers STD testing.
Confidentiality and Urgent Care
Confidentiality is a crucial factor in the provision of STI screening and treatment services. You can rest assured that all 50 states and DC allow minors to consent to STI services.
However, 18 states allow physicians to inform a parent or guardian that the minor is seeking these services. This can be a challenge, especially for minors who want to keep their health information private.
If you're under 26 and covered as a dependent on your parent's insurance policy, you should know that an Explanation of Benefits (EOB) summary is sent to the primary policyholder when you use health services, including STI screening. This can raise concerns about privacy and confidentiality.
Fortunately, seven states (CA, CO, HI, MD, ME, OR, and WA) have implemented broad laws to ensure confidentiality for minors seeking sensitive services like STI screenings.
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Confidentiality
Confidentiality is a crucial factor in the provision of STI screening and treatment services, especially for minors.
Although all 50 states and DC allow minors to consent to STI services, 18 states allow physicians to inform a parent or guardian that the minor is seeking these services.
The Trump Administration's new final regulations for the Title X program have broadened its requirements to encourage family participation, which may deter minors from seeking services due to concerns about confidentiality.
Approximately 11.1 million young adults aged 19-25 were covered as dependents in an employer-sponsored insurance policy in 2018, raising concerns about privacy and confidentiality in the use of sensitive health services such as STI screening and treatment.
71% of women ages 18 to 25 rated confidentiality as important to them, but only 37% understood that an Explanation of Benefits (EOB) summary is sent to the primary policyholder (typically the parent) when health services are used.
Seven states (CA, CO, HI, MD, ME, OR, and WA) have implemented broad laws to ensure confidentiality for minors seeking sensitive services such as STI screenings.
Some states (CA, MD, and OR) require insurers to provide confidential communications upon the written request of the covered dependent, including minors.
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Urgent Care Covered by Insurance
Urgent care centers often provide STD testing, and in many cases, this testing is covered by insurance. You'll need to confirm with your insurance company and the urgent care facility to determine the specifics of your coverage.
The Affordable Care Act (ACA) requires most health insurance plans to cover testing for certain STDs, including HIV, syphilis, chlamydia, and gonorrhea. These tests are often part of your preventive care benefits, which means they're free with no copay or out-of-pocket costs.
However, coverage for other STD tests may vary depending on your age, gender, risk factors, and other factors. It's a good idea to talk with your nurse or doctor or call your health insurance provider to find out what STD tests are covered for you and how much they'll cost if you have to pay out of pocket.
Here are some examples of STD tests that may be covered by insurance:
- HIV testing for everyone ages 15 to 65 (and other ages if you have a higher risk for getting HIV)
- Syphilis, chlamydia, and gonorrhea tests (often part of your preventive care benefits)
- Other STD tests (may be covered, but costs may vary)
Keep in mind that even if you don't have insurance, there are options for affordable care. You can call your local Planned Parenthood health center to see if they can help you get care for free or low-cost.
Coverage Inquiry
Most health insurance plans cover testing for certain STDs, including HIV, syphilis, chlamydia, and gonorrhea, as part of preventive health benefits.
You can find out what STD tests are covered for you by talking with your nurse or doctor or calling your health insurance provider.
The cost of STD tests can vary, but some may be free with no copay, coinsurance, or other out-of-pocket costs, even if you haven't met your deductible.
If you need STD testing or treatment that's not covered by your health insurance, or if you don't have health insurance, you can call your local Planned Parenthood health center to see if they can help you get care for free or low-cost.
Medicare Part B (Medical Insurance) covers sexually transmitted infection screenings and behavioral counseling sessions if you're eligible, and you pay nothing if your provider accepts assignment.
Here are the details of what's covered by Medicare Part B:
- Sexually transmitted infection screenings for chlamydia, gonorrhea, syphilis, and/or Hepatitis B once every 12 months for individuals at increased risk for an STI or at certain times during pregnancy for pregnant individuals.
- Up to 2 face-to-face, high-intensity behavioral counseling sessions, each 20-30 minutes long, once each year for sexually active individuals at increased risk for STIs.
- An HIV screening once per year for individuals age 15-65 without regard to perceived risk or for individuals outside of this age range who are at an increased risk for HIV.
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