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Medicare Could Soon Pick Up Tab for STD Testing for Seniors

By Bill Toland, Pittsburgh Post-Gazette

March 8, 2011

Taxpayers could soon be picking up the tab for new sexually transmitted disease screenings for seniors, as well as other Medicare recipients.

More than a decade after Viagra and its ilk began helping boomers and seniors to enjoy conjugal relations more frequently, sexually transmitted disease rates are up dramatically in the over-40 age bracket.

And while wisdom is supposed to come with age, studies have also shown that men over 50 -- regardless of marital status -- are six times less likely to use a condom than men in their 20s, partly because, by that age, they (and their partner) are less worried about pregnancy.

Add in improved senior health and a higher divorce rate, and the result nearly seems inevitable: According to the Centers for Disease Control and Prevention, STD rates are up by almost 50 percent for men over 40 between 1996 and 2008.

Already, Medicare pays for HIV screenings. But the federal Centers for Medicare and Medicaid Services ( CMS ), which governs both programs, may add new STD exams to the list of exams reimbursed by Medicare, the federal health insurance program for almost 40 million American seniors.

The screenings could help save money down the road by providing early detection of syphilis, gonorrhea and hepatitis B, which could prevent expensive treatments later on, according to Reuters news.

In order to add the coverage, CMS must first initiate a "national coverage analysis" to determine if the screenings are needed. CMS will be studying chlamydia screenings for sexually active Medicare recipients and pregnant women; gonorrhea screenings for sexually active Medicare recipients; syphilis infection screenings for "all those at increased risk;" and hepatitis B virus screenings for pregnant Medicare recipients. CMS may also reimburse behavioral counseling for both sexually active seniors on Medicare and adolescents.

In general, older people are having sex more often than might be expected, though health experts say the idea that seniors grow inevitably asexual is a myth.

A 2007 study published by the New England Journal of Medicine, "A Study of Sexuality and Health Among Older Adults in the United States," reported that 67 percent of men and 39 percent of women aged 65 to 74 who were polled had sex in the previous year. And 38 percent of men aged 75 to 85 reported the same.

"We should not be profiling people based on their age, making assumptions on their sexual activity," said Stacey Lindau, an obstetrician and gynecologist at the University of Chicago , and lead author on that 2007 study. "Removing aged-based profiling with respect to STD screenings is a good idea."

In some respects, she said, seniors can be at elevated risk for STDs. Public health messaging isn't aimed at them, and there is a stigma in senior populations when it comes to talking about sex or admitting you're still having it.

As for condoms, older men don't use them for a variety of reasons -- not just because the risk of pregnancy has elapsed. "Asking your partner to use a condom [at that age] may suggest a lack of trust," Dr. Lindau said. And condoms might not work as well for older men for physiological reasons.

What role do erectile drugs play in senior STD rates? Studies have shown that older men using Viagra and similar drugs have higher STD rates than non-users. But the same studies also show that the men who used the erectile drugs were also more likely to acquire an STD before they were first prescribed the drug.

In other words, the men who use erectile drugs may be behaviorally more susceptible to STDs because they are more sexually active to begin with.

Improved senior health rates and a divorce rate that has increased over the last several decades also play a role in the elevated STD rates among erectile drug users.

Erectile drug users "are already having riskier sex more often than men who did not fill those prescriptions," said Anupam Jena, an internist at Massachusetts General Hospital . That means the link between Viagra, Cialis, Levitra and STDs might not be directly causal.

Still, common sense suggests to Dr. Jena that a pill enabling a new population to have sex more often would have to translate in higher incidences in STDs. "Almost by definition, you'd have to assume sexual activity will go up" in that age bracket. If sexual activity goes up, STD rates will go up, too.

He and colleagues are working on a second round of studies on the same subject, and new evidence, he said, "is pointing toward a more cause-and-effect relationship." Dr. Jena said providing additional Medicare reimbursement for senior STD screenings is the right move.

"Having an STD illness is something that affects not only you, but others around you," he said. As a matter of public health, "The federal government should be involved in subsidizing tests that screen for those diseases."

The Medicare-covered tests aimed at seniors would, if approved, be part of a larger push for preventative and STD screenings aimed at a variety of vulnerable populations, such as pregnant women, or disabled people. In addition to the tens of millions of seniors enrolled in Medicare, about 7.6 million disabled people also are covered.

Since 2009, CMS has been authorized to add more coverage for screenings to the Medicare plan; diabetes, colorectal cancer and Pap smear screenings already are covered by Medicare.

In January, the Annals of Family Medicine published research indicating that Medicare's screening policies are lacking in a few areas. They don't provide reimbursement for a handful of screenings that are recommended by health care experts but cover other screenings that are not considered as vital (such as abdominal aortic aneurysm screenings in women).

CMS is planning to issue its new Medicare screening recommendations by Aug. 24. The agency is accepting public comment on the potential coverage changes through the fourth week of March.

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