Paying cash vs using insurance for STD testing

If you have health insurance, some STD screening may cost you nothing. Many people still pay cash. A posted price is easy to compare, there's no appointment to book, and no claim goes to the plan. Which is cheaper depends on your plan, your deductible and which tests you need.

Key points

• Marketplace plans and many other plans must cover certain STI screenings with no copay or coinsurance when you use an in-network provider. The list depends on age, sex and risk.
• Tests outside that list may go toward your deductible, so you pay the plan's rate until the deductible is met.
• Several online testing services don't bill insurance. Their price is the full price.
• An insurance claim produces an explanation of benefits. Paying the provider directly does not.
• An HSA or FSA can pay for a cash test, which lowers the real cost if you have one.

What insurance must cover

HealthCare.gov says all Marketplace plans and many other plans must cover a list of preventive services "without charging you a copayment or coinsurance," even before you meet your deductible, when an in-network provider delivers them. The STI-related items for adults include:

• HIV screening for everyone 15 to 65, and other ages at increased risk.
• Hepatitis C screening for adults 18 to 79.
• Hepatitis B screening for people at high risk.
• Syphilis screening for adults at higher risk.
• STI prevention counseling for adults at higher risk.

For women, the list adds chlamydia screening for younger women and others at higher risk, and gonorrhea screening for women at higher risk. They line up with U.S. Preventive Services Task Force recommendations, such as HIV screening for ages 15 to 65 and hepatitis C screening for adults 18 to 79.

There are limits. HealthCare.gov adds that "coverage may vary" and that a zero cost isn't guaranteed in every case. Grandfathered plans, meaning certain plans that existed before the Affordable Care Act, may not include some of its protections. Herpes, trichomoniasis and HPV testing outside cervical cancer screening aren't on the STI list.

When paying cash makes sense

• You need tests outside the covered list, or you're outside the groups it names. Those tests may go toward your deductible, which means you pay for them yourself until the deductible is met.
• You have a high deductible you haven't met. Until you meet it, you pay for covered services that aren't preventive. HealthCare.gov defines the deductible as "the amount you pay for covered health care services before your insurance plan starts to pay."
• You don't want a claim on the plan. This matters most if someone else holds the policy.
• You want to skip the appointment. Private services let you order online and go straight to a lab or use a home kit.
• You don't have insurance.

When insurance makes sense

• You're in a covered group and have an in-network doctor or clinic you can see soon. The screening may cost nothing.
• You need a visit anyway, for example for symptoms or treatment.
• You're pregnant. CDC recommends syphilis, HIV and hepatitis B testing at the first prenatal visit, and your care team will order it.

Several online services don't take insurance

Several of the services we compare say so on their own pages:

• STDcheck says it does "not currently accept insurance" but can give an itemized receipt "for insurance reimbursement purposes."
• Priority STD Testing says it will "never directly bill your insurance."
• Quest's consumer site says it does not bill insurance and that "purchases cannot be submitted for insurance reimbursement."
• Labcorp OnDemand says self-initiated tests "aren't covered by insurance and don't apply to annual deductibles."

If you plan to ask your insurer to reimburse a cash test, call the plan first. Ask whether it accepts claims you submit yourself and whether out-of-network rules apply.

Claims, EOBs and privacy

An explanation of benefits, or EOB, is the statement your insurer sends after a claim. The Texas Department of Insurance says, "It's not a bill. Your insurance company sends an explanation of benefits to let you know it got a claim." On a family plan, it goes to the address the plan has on file.

HIPAA gives you two tools here:

• If you pay a covered provider in full out of pocket, you can ask it not to share that service with your health plan. HHS says the provider must agree unless a law requires the disclosure.
• You can ask your plan to send communications to a different address. HHS says plans must accommodate reasonable requests if you say the disclosure could endanger you.

Our privacy and medical records guide has more detail.

A quick way to compare

1. Check whether the tests you need are on the preventive list for someone your age and sex, at your level of risk.
2. If yes, find an in-network clinic and ask how soon you can be seen.
3. If no, or if you'd rather not file a claim, compare cash prices in our comparison table.
4. If you have an HSA or FSA, use it for the cash test. See using an HSA or FSA.

The IRS counts lab fees that are part of medical care as medical expenses. That's why HSA and FSA funds work for these tests.