STD Preventive Services

The Affordable Care Act requires coverage of recommended preventive services without cost-sharing for the following health plans:

  1. Non-grandfathered private health insurance plans – Most private insurance plans, including all plans on the Health Insurance Marketplace, and all group or individual health insurance plans that did not exist on March 23, 2010—or that have made significant changes to benefits, cost-sharing, or limits since that time—are required to cover services without cost-sharing.1,2
  2. Medicare – All USPSTF recommended services that have a Grade “A” or “B” and that are covered by Medicare must be covered without cost-sharing.3
  3. Medicaid expansion plans in states that expanded (i.e. Alternative Benefit Plans) – Medicaid expansion plans offered by states that extend Medicaid eligibility to non-elderly individuals with annual incomes at or below 133 percent of the federal poverty level ($16,040 for an individual or $32,718 for a family of 4 in 2017) are required to cover services without cost-sharing.4,5
  4. Traditional Medicaid plans – Those states that, at their option, cover without cost-sharing in their standard Medicaid benefit package all USPSTF-recommended services that have a Grade “A” or “B” and all ACIP-recommended vaccines receive an increase in their federal medical assistance for such services and vaccines.6

In addition to these services, private and public plans may cover other preventive services without cost-sharing.

Preventive services for STDs that may be covered without cost-sharing, pursuant to Affordable Care Act (ACA) requirements.
Preventive Service Recommending Authority (authorized under Section 1001 of the Patient Protection and Affordable Care Act) Eligible Populations and Service Specifics Health Insurance Plans That Cover the Service Without Cost-Sharing
Chlamydia Testing USPSTF
(Grade “B” recommendation September 2014)
Screen the following groups for chlamydia:
  • sexually active women (including pregnant women) age 24 years and younger;
  • sexually active older women (including pregnant women) who are at increased risk for chlamydia infection7

(See Final Recommendation Statement: Chlamydia and Gonorrhea: Screening – US Preventive Services Task ForceExternal for additional information.)

  • Non-grandfathered private health insurance plans
  • Medicare Medicare covers chlamydia screening in the following cases:
    • annually for non-pregnant women at increased risk of STI, including all sexually active women <= 24 years of age;
    • at the time pregnancy is determined for all pregnant women <= 24 years of age or who are at increased risk; and
    • in the 3rd trimester for all pregnant women who have ongoing exposure risks.8
  • Medicaid expansion plans
  • Traditional Medicaid plans
    Optional.
Bright Futures Recommendations for Pediatric Preventive Health Care
(American Academy of Pediatrics, 2017)
STI screening for sexually active adolescents (11-21 years of age).9
(See Recommendations for Preventive Pediatric Health CareCdc-pdfExternal for additional information.)
  • Non-grandfathered private health insurance plans
  • Medicaid expansion plans
  • Traditional Medicaid plans
    Optional as above. In general, preventive services for children are covered Included as part of the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit for children; cost-sharing may apply in some cases.
Syphilis Testing USPSTF
(Grade “A” recommendation for non-pregnant adults and adolescent women issued June 2016)
Screen persons at increased risk for syphilis infection.10
(See USPSTF Final Recommendation Statement: Syphilis Infection in Nonpregnant Adults and Adolescents: Screening External for additional information)
  • Non-grandfathered private health insurance plans
  • Medicare Medicare covers annual syphilis screenings for men and women at increased risk for STIs.8
  • Medicaid expansion plans
  • Traditional Medicaid plans
    Optional as above.
USPSTF
(Grade “A” recommendation for pregnant women issued May 2009)
Screen all pregnant women for syphilis infection.10
(See USPSTF Final Recommendation Statement: Syphilis Infection in Pregnancy: ScreeningExternal for additional information)
  • Non-grandfathered private health insurance plans
  • Medicare Medicare covers syphilis screenings for:
    • pregnant women when the diagnosis of pregnancy is known, and then repeat screening during the third trimester and at delivery if high-risk sexual behavior has occurred since the previous screening test; and
    • men and women at increased risk for STIs annually.8
  • Medicaid expansion plans
  • Traditional Medicaid plans
    Optional as above.
Bright Futures Recommendations for Pediatric Preventive Health Care
(American Academy of Pediatrics, 2017)
Screen sexually active adolescents (11-21 years of age) for STIs9
(See Recommendations for Preventive Pediatric Health CareCdc-pdfExternal for additional information.)
  • Non-grandfathered private health insurance plans
  • Medicaid expansion plans
  • Traditional Medicaid plans
    Optional as above. In general, preventive services for children are covered Included as part of the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit for children; cost-sharing may apply in some cases.
Gonorrhea Testing USPSTF
(Grade “B” recommendation issued September 2014)
Screen the following groups for gonorrhea:
  • sexually active women (including pregnant women) age 24 years and younger;
  • sexually active older women (including pregnant women) who are at increased risk for gonorrhea infection7

(See Final Recommendation Statement: Chlamydia and Gonorrhea: Screening – US Preventive Services Task ForceExternal for additional information.)

  • Non-grandfathered private health insurance plans
  • Medicare Medicare covers gonorrhea screening in the following cases:
    • annually for non-pregnant women at increased risk of STI, including all sexually active women <= 24 years of age;
    • at the time pregnancy is determined for all pregnant women <= 24 years of age or who are at increased risk;
    • in the 3rd trimester for all pregnant women who have ongoing exposure risks.8
  • Medicaid expansion plans
  • Traditional Medicaid plans
    Optional as above.
Bright Futures Recommendations for Pediatric Preventive Health Care
(American Academy of Pediatrics, 2017)
Screen sexually active adolescents (11-21 years of age) for STIs9
(See Recommendations for Preventive Pediatric Health CareCdc-pdfExternal for additional information.)
  • Non-grandfathered private health insurance plans
  • Medicaid expansion plans
  • Traditional Medicaid plans
    Optional as above. In general, preventive services for children are covered Included as part of the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit for children; cost-sharing may apply in some cases.
Ocular Prophylaxis for Gonococcal Ophthalmia Neonatorum USPSTF
(Grade “A” recommendation issued July 2011)
Provide prophylactic ocular topical medication to all newborns for the prevention of gonococcal ophthalmia neonatorum.12
(See USPSTF Final Recommendation Statement: Ocular Prophylaxis for Gonococcal Ophthalmia Neonatorum: Preventive MedicationExternal for additional information.
  • Non-grandfathered private health insurance plans
  • Medicaid expansion plans
  • Traditional Medicaid plans
    Optional as above.
Human Papillomavirus Testing Women’s Preventive Services Guidelines
(December 2016)
Screen average-risk women aged 21 to 65 years for cervical cancer.
  • For women aged 21 to 29 years, using cervical cytology (Pap test) every 3 years.
  • Women aged 30 to 65 years should be screened with cytology and human papillomavirus testing every 5 years or cytology alone every 3 years.13

(See Women’s Preventive Services GuidelinesExternal for additional information.)

  • Non-grandfathered private health insurance plans
  • Medicare Medicare covers screening once every five years asymptomatic beneficiaries aged 30 to 65 years in conjunction with the Pap - test.14
  • Medicaid expansion plans
USPSTF
(Grade “A” recommendation issued March 2012)
Screen women ages 21 to 65 for cervical cancer with cytology (Pap smear) every 3 years or, for women age 30 to 65 years who want to lengthen the screening interval, screening with a combination of cytology and human papillomavirus (HPV) testing every 5 years15
(See USPSTF Final Recommendation Statement: Cervical Cancer: ScreeningExternal for additional information)
  • Non-grandfathered private health insurance plans
  • Medicare Medicare covers screening once every five years asymptomatic beneficiaries aged 30 to 65 years in conjunction with the Pap - test.14
  • Medicaid expansion plans
Human Papillomavirus Vaccination Advisory Committee on Immunization Practices (ACIP)
(March 2015)
Initiate routine vaccination for males and females ages 11-1216.
Also vaccinate members of the following groups if they have not been vaccinated previously or have not completed the 3-dose series16:
  • females 13-26 years of age,
  • males 13-21 year of age, and
  • MSM and immunocompromised persons through 26 years16

(See Use of 9-Valent Human Papillomavirus (HPV) Vaccine: Updated HPV Vaccination Recommendations of the Advisory Committee on Immunization Practices for additional details)

  • Non-grandfathered private health insurance plans
  • Medicaid expansion plans
  • Traditional Medicaid plans
    Optional as above.
Sexually Transmitted Infection (STI) and HIV Prevention Counseling USPSTF
(Grade “B” recommendation issued September 2014)
Provide intensive behavioral counseling to prevent sexually transmitted infections (STIs) to all sexually active adolescents and for adults at increased risk for STIs.17
(See USPSTF Final Recommendation Statement: Sexually Transmitted Infections: Behavioral CounselingExternal for a discussion of risk factors.)
  • Non-grandfathered private health insurance plans
  • Medicare Medicare covers up to two individual 20 to 30 minute, face-to-face, high intensity behavioral counseling sessions annually for Medicare beneficiaries for all sexually active adolescents and for adults at increased risk for STIs.8
  • Medicaid expansion plans
  • Traditional Medicaid plans
    Optional as above.
Women’s Preventive Services Guidelines
(December 2016)
Provide annual counseling on sexually transmitted infections, including HIV, for all sexually active women.13
(See Women’s Preventive Services GuidelinesExternal for additional information.)
  • Non-grandfathered private health insurance plans
  • Medicaid expansion plans
References
  1. 42 U.S.C. § 300gg–13External
  2. Coverage of Certain Preventive Services Under the Affordable Care ActExternal; U.S. Department of Health & Human Services
  3. 42 U.S.C. § 1395lExternal
  4. 42 U.S.C. § 1396aExternal
  5. Medicaid and Children’s Health Insurance Programs: Essential Health Benefits in Alternative Benefit Plans, Eligibility Notices, Fair Hearing and Appeal Processes, and Premiums and Cost Sharing; Exchanges: Eligibility and Enrollment.Cdc-pdfExternal 78 FR 42159; 42224-42226. July 2013
  6. 43 U.S.C. § 1396dExternal
  7. Final Recommendation Statement: Chlamydia and Gonorrhea: ScreeningExternal. U.S. Preventive Services Task Force. September 2014.
  8. National Coverage Determination (NCD) for Screening for Sexually Transmitted Infections (STIs) and High-Intensity Behavioral Counseling (HIBC) to Prevent STIs (210.10)External. Centers for Medicaid and Medicare Services. November 2011.
  9. 2016 Recommendations for Preventive Pediatric Health Care. Cdc-pdfExternal Committee on Practice and Ambulatory Medicine and Bright Futures Periodicity Schedule Workgroup. Pediatrics 2016;137.
  10. Final Recommendation Statement: Syphilis Infection in Nonpregnant Adults and Adolescents: ScreeningExternal. U.S. Preventive Services Task Force. June 2016.
  11. Final Recommendation Statement: Syphilis Infection in Pregnancy: ScreeningExternal. U.S. Preventive Services Task Force. May 2009.
  12. Final Recommendation Statement: Ocular Prophylaxis for Gonococcal Ophthalmia Neonatorum: Preventive MedicationExternal. U.S. Preventive Services Task Force. July 2011.
  13. Women’s Preventive Services Guidelines. Health Resources and Services Administration; December 2016.
  14. National Coverage Determination (NCD) for Screening for Cervical Cancer with Human Papillomavirus (HPV) (210.2.1)External. Centers for Medicaid and Medicare Services. July 2015.
  15. Final Recommendation Statement: Cervical Cancer: Screening.External U.S. Preventive Services Task Force. March 2012.
  16. Use of 9-Valent Human Papillomavirus (HPV) Vaccine: Updated HPV Vaccination Recommendations of the Advisory Committee on Immunization Practices. Centers for Disease Control and Prevention. MMWR March 27, 2015 / 64(11);300-304.
  17. Final Recommendation Statement: Sexually Transmitted Infections: Behavioral CounselingExternal. U.S. Preventive Services Task Force. September 2014.

Page last reviewed: May 2, 2018