Figuring out how to pay for medical care can be a challenge. The good news is that many sexual health services are covered by health insurance. If you don’t have health insurance, there are options for low- to no-cost services in Massachusetts. Learn more about your options to help pay for the care you need.
Most insurance plans, including MassHealth, cover the cost of STI and HIV testing. Most plans will also cover services related to PrEP, a medication that helps prevent HIV, and PEP, a medication taken after HIV exposure.
How much is covered depends on your individual plan. Even if a service is covered, it may not be completely free to you, depending on your plan. Your insurance may still require you to pay:
You can call your insurance company’s member services to check if your plan fully covers the services you need, and if not, how much you will need to pay out of pocket.
You can find sexual health services for low- to no-cost at these health centers and clinics affiliated with the Massachusetts Department of Public Health.
You can use these health centers and clinics even if you have health insurance. Your insurance plan may be billed for services, but there will likely be no out-of-pocket costs.
Most insurance plans, including MassHealth, cover the cost of STI and HIV testing.
If you do not have health insurance, many health clinics and testing sites offer low or no-cost testing, and can even help you enroll in health insurance.
Most health insurance plans, including MassHealth, usually cover some or all of the cost of PrEP (pre-exposure prophylaxis), a medication that can help prevent HIV. This includes clinic visits, prescriptions, and laboratory tests. Check with your insurance company to find out if your plan covers PrEP.
If you need help with your copayments (copays), the Massachusetts PrEP Drug Assistance Program (PrEPDAP) may be able to help cover the cost. PrEPDAP also assists eligible clients by covering out-of-pocket costs for PrEP, such as copays and payments towards an insurance deductible.
If you have Medicare, these services are covered without cost sharing, so you do not pay deductibles or copays. Some people with Medicare may have previously gotten PrEP for HIV drug coverage through Part D and paid a deductible, coinsurance, or copays. As of September 2024, Part B covers these drugs without cost sharing. Learn more about Medicare Part B and PrEP coverage.
If you don’t have health insurance, there are programs in Massachusetts that can help cover the cost of PrEP.
The Massachusetts Pre-Exposure Prophylaxis Drug Assistance Program (PrEPDAP) can help cover the cost of PrEP. The program is open to Massachusetts residents who are HIV-negative and meet certain income requirements. You can find out more about the eligibility on the PrEPDAP program page.
In order to continue taking PrEP, your health care provider will likely require retesting for HIV and STIs. If you’re concerned about the cost of regular testing, check out these in Massachusetts that may help lower or cover the cost of testing.
Post-Exposure Prophylaxis (PEP), a medication taken after a potential exposure to prevent HIV, is usually covered by health insurance. If you don’t have insurance, or if you have insurance but can’t afford the co-pays for PEP medications, the PEP Program may be able to cover the cost. PEP is a program of the Massachusetts Department of Public Health administered by Community Resource Initiative (CRI).
The Massachusetts HIV Drug Assistance Program (HDAP) helps people living with HIV pay for HIV medications and health insurance.
The Ryan White Dental Program (RWDP) provides oral health services to people who are living with HIV and don’t have access to comprehensive dental care. To learn more about eligibility and how to apply, visit the RWDP site or call (617) 534-2344. RWDP is a program of the Boston Public Health Commission and is available for people living with HIV throughout Massachusetts.
If you are employed, check with your job to learn if they provide health insurance as a benefit. Many companies and organizations offer health plans, which may also include dental and vision plans.
If your job doesn’t offer a plan or if you’re unemployed, the Massachusetts Health Connector is the state’s marketplace for health and dental insurance. You can compare plans and see if you’re eligible for low or no-cost benefits including MassHealth. The open enrollment period typically runs from November to January, but you can enroll in coverage any time of the year if you are applying for dental plans or if you’ve experienced a qualifying life event. Qualifying life events can include changes in your household such as marriage, divorce, death of a spouse, birth or adoption of a child, or job loss resulting in loss of health insurance.
You may also be eligible for Massachusetts Medicaid, also called MassHealth, which pays for health care for eligible Massachusetts residents. The program offers health care benefits directly or by paying part or all of your health insurance premiums (the amount you pay for your insurance plan). To learn more about the program, visit the MassHealth site.
If you are 25 years old or younger and your parents or legal guardian have health insurance, you may be able to stay on their plan if you are claimed as a dependent.
If you are on your parents’ or partner’s insurance and are worried about keeping your medical information private, see the information below about being on a parent or partner’s insurance plan.
Sometimes, the subscriber of the plan (such as a parent or partner) gets an insurance form summarizing your visits. It may list the place, date, and cost of the visits. If you are on someone else’s health insurance and you are worried about them getting billed for services or seeing what services you have accessed, you may be able to keep your billing private. Your insurance company may be able to send these forms directly to you instead, or it may not send these explanations automatically. The PATCH Act, a Massachusetts law that protects patient confidentiality when multiple people are on the same insurance plan, makes this possible. Find out more about the PATCH Act and how it can help you maintain your privacy and confidentiality.
You can ask to have your billing information kept private when you get services like:
To ask if you can receive the insurance form directly, you must call your insurance company (use the customer service phone number on your insurance card). Ask if you can receive insurance billing information directly, instead of your parent or partner. Provide any information you are asked for such as the policy number on your insurance card and the visit dates. The insurance plan will inform you if you can make this change.
Find out more about how you can request to keep your information private.
Find low- to no-cost sexual health services near you, like PrEP, STI testing, and more on the Service Locator Map.
PrEP is a medication that helps prevent HIV. Take a short quiz to find out if it may be right for you.