Does Medicare Cover Hepatitis C Treatment?
This article was updated on: 11/09/2017
If you have hepatitis C and you’re on Medicare, you may be wondering if Medicare covers hepatitis c treatment.
Medicare may cover a variety of diagnostic services and preventive care for beneficiaries with hepatitis C. Treatment for hepatitis C generally involves certain prescription drugs, according to the Centers for Disease Control.
What is hepatitis C?
According to the National Institutes of Health, hepatitis C (also known as hep C) is inflammation (swelling) in the liver caused by a virus. Some people might respond well to hepatitis C treatment, but many people don’t, and can have the disease for years.
The Centers for Disease Control reports that there is currently no vaccine available to prevent hepatitis C.
Hepatitis C treatment: screening comes first
Of course, you won’t need “hep C” treatment unless you have the disease. Medicare Part B may cover a one-time hepatitis C screening test if it’s ordered by your primary care doctor or health-care practitioner.
In some situations, Medicare covers a repeat hepatitis C screening once a year if you’re considered high risk for getting the condition. You’re considered high risk for contracting hepatitis C if you meet at least one of the following conditions:
- You were born between 1945 and 1965.
- You had a blood transfusion before 1992.
- You currently use illicit injection drugs, or you have a past history of illicit injection drug use.
You’ll pay nothing for this hepatitis C test if your doctor accepts Medicare assignment, meaning that he or she agrees to accept the cost Medicare has approved for the test as full payment and not charge you above that (outside of cost sharing, if any).
Hepatitis C treatment: Medicare coverage
Here’s an overview of the types of hepatitis C treatment Medicare might cover.
If you’ve been diagnosed with this disease, you may want to discuss hepatitis C treatment options with your health-care provider. Depending on how mild or severe your disease is, you may only require regular monitoring by your physician and follow-up tests to check the condition of your liver. Medicare Part B may cover outpatient services like office visits, lab tests, and physician services.
Having hepatitis C doesn’t prevent you from getting other forms of hepatitis, including hepatitis A and hepatitis B. Because of this, people with chronic hepatitis C, and especially those with liver damage, may want to get vaccinated against hepatitis A or B to prevent further liver complications. Talk to your doctor to see if you should get these vaccinations.
While there are vaccines available for both hepatitis A and B, Medicare only covers the hepatitis B vaccine. If your doctor recommends that you get the hepatitis B shot, Medicare Part B covers the vaccination if you are enrolled in Part B and considered high or medium risk for hepatitis B due to having end-stage renal disease, diabetes, hemophilia, or other conditions that make you more vulnerable to infection. The hepatitis B shot is generally free if you get it through a health-care provider who accepts assignment.
Hepatitis C medications: Medicare coverage
Doctors may prescribe hepatitis C medications to treat or manage the disease. Hepatitis C treatment through prescription medications has improved in recent years, with more effective drugs with fewer side effects than those available in the past, the Department of Health and Human Services (HHS) reported in 2017.
Original Medicare doesn’t cover most prescription drugs except in limited inpatient and outpatient settings. For example, if you’re hospitalized, Medicare Part A usually covers prescription drugs that are part of your inpatient treatment. Under Part B, Medicare generally covers certain types of prescription drugs you get in an outpatient setting (like a doctor’s clinic), although these tend to be the type of medications you need a doctor to give you (such as infusion medications).
For coverage of other medications used for hep C treatment, prescription drug coverage is available under Medicare Part D. You generally have two options:
- Enroll in a stand-alone Medicare Prescription Drug Plan (which works alongside Original Medicare)
- Enroll in a Medicare Advantage Prescription Drug plan, which offers at least the same benefits as Original Medicare (except hospice) and includes prescription drug coverage.
Both types of plans are available through Medicare-approved private insurance companies.
Hepatitis C treatment: how to make sure your Medicare Prescription Drug Plan covers your medications
If you’re taking prescription drugs as part of your hepatitis C treatment or management, you might want to make sure that any Medicare plan you’re considering covers your prescription medications. It’s easy to look up this information by checking the plan’s formulary, or list of covered drugs.
Every Medicare plan that includes prescription drug coverage has a formulary, but the specific medications that are covered and their costs may vary by plan. A Medicare Advantage Prescription Drug plan or stand-alone Medicare Prescription Drug Plan may change its formulary at any time; however, the plan will notify you of formulary changes when necessary.
There’s an easy, quick way to see if your hepatitis C treatment prescription drugs may be covered by a Medicare Prescription Drug Plan in your area. Just click Find Plans or Compare Plans on this page, enter your zip code, and you should be able to click on a link that lets you enter your prescriptions.
Hepatitis C treatment: Medicare coverage of liver transplants
In severe cases, your doctor might recommend a liver transplant might be recommended for hepatitis C patients. In fact, according to the Centers for Disease Control, hepatitis C is the most common reason for liver transplant surgery in the United States.
If this is medically necessary for your hep C treatment, Medicare Part A generally covers the hospital portion of the procedure under certain conditions at an approved, Medicare-certified facility, while Medicare Part B may cover any doctor services needed as part of your liver transplant.
You’ll typically be responsible for paying 20% of the Medicare-approved amount for doctor services for hepatitis C treatment, and the Part B deductible applies. Medicare generally covers your lab tests as part of your hepatitis C treatment. You may need to pay various out-of-pocket costs- for example, for doctor visits and transplant facility charges.
I hope you now have a better understanding of how Medicare covers hepatitis C treatment and what your options may be. Are you looking for more coverage to help with your hepatitis C treatment or management? I can help you find a or a Medicare Advantage Prescription Drug Plan that may fit your health needs and your budget.
You can click one of the links below to set up a time to talk by phone or get a personalized email with plan information. Compare the plan options in your location by clicking the Compare Plans or Find Plans buttons on this page. I or another Medicare.com licensed insurance agent can answer your questions at the number below; feel free to give us a call for personalized assistance.
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