Does Medicare cover chronic liver disease?
This article was updated on: 09/10/2018
Statistics from the Centers for Disease Control and Prevention (CDC) suggest that nearly 4 million Americans suffer from chronic liver disease, or about 1.6% of all adults. If you or someone you love has chronic liver disease and are enrolled in Medicare, here’s what you should know about Medicare coverage for chronic liver disease.
What causes chronic liver disease?
According to a journal published in the U.S. National Library of Medicine, the liver plays a central role in your body’s metabolic processes. It breaks down fat to produce energy, helps keep blood sugar levels stable, and helps the body filter and remove toxins in the blood. Damage to the liver causes scarring (cirrhosis), which over time can lead to chronic liver disease, which may be life-threatening.
There is no one specific cause for chronic liver disease; the Mayo Clinic states that it has many causes, including:
- Viral or parasitic infections, most typically hepatitis A, hepatitis B, and hepatitis C
- An autoimmune disorder such as primary biliary cirrhosis, autoimmune hepatitis, and primary sclerosing cholangitis
- Genetic or inherited disorders such as Wilson’s disease or hemochromatosis
- Cancers of the liver and surrounding structures
- Chronic alcohol abuse
- Fatty liver disease not caused by alcohol
According to the Mayo Clinic, you may be at higher risk for chronic liver disease if you have a history of the following:
- Heavy alcohol use
- IV drug use
- Blood transfusions prior to 1992
- High triglycerides
The Mayo Clinic suggests you can reduce your risk of developing chronic liver disease if you follow these recommendations:
- Use alcohol in moderation.
- Get vaccinated against hepatitis.
- Don’t mix prescription or over-the-counter medications and alcohol, and only use medications as directed.
- Avoid risky behaviors such as unprotected sex and IV drug use.
- Maintain a healthy weight.
How is chronic liver disease treated?
The process for diagnosing chronic liver disease, according to the Mayo Clinic, may involve blood tests, imaging studies such as a CT scan or MRI, and even a tissue biopsy.
Depending on the cause and extent of the chronic liver disease, your doctor may recommend treatment with lifestyle changes such as weight loss and diet modification, alcohol cessation, and possibly prescription medication.
In some cases, you may need a liver transplant to treat chronic liver disease.
How does Medicare cover chronic liver disease?
Generally, Medicare covers allowable charges for your tests and doctor visits to diagnose and treat chronic liver disease; you may have to pay your Medicare Part A or Part B deductibles and coinsurance amounts depending on whether you get care as an inpatient or outpatient.
If you have Medicare Part D prescription drug coverage, your plan will generally pay for most medications to treat chronic liver disease, less any applicable deductibles and copayment/coinsurance amounts. You can get Part D coverage through a stand-alone Part D Prescription Drug Plan or a Medicare Advantage Prescription Drug plan.
Part B also generally pays for obesity screening and behavioral counseling sessions to help you lose weight if your doctor believes it is beneficial to treat your chronic liver disease. You may pay nothing for these services if you get them in a doctor’s office and your provider accepts assignment. If you have Medicare Advantage, your plan may offer additional benefits to help you achieve and maintain a healthy weight, such as wellness services and discounted gym memberships.
If you have chronic liver disease and you need help with alcohol cessation, Medicare generally covers allowable charges for inpatient treatment, partial hospitalization, and outpatient alcohol counseling. Your Part A and Part B deductibles, copayments, and/or coinsurance amounts may apply.
Should your doctor recommend a liver transplant, allowable charges for your surgery, hospitalization, and certain transplant medications are covered as long as you get treated in a Medicare-approved transplant hospital and you meet certain transplant requirements. Your deductible, copayment, and/or coinsurance amounts may apply.
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