Does Medicare Cover Hepatitis?
This article was updated on: 05/28/2019
If you have been diagnosed with hepatitis, you may have many questions about your disease and how your Medicare coverage pays for your treatment. There are five main types of hepatitis: A, B, C, D, and E; each has a different cause and a different course of treatment.
Hepatitis A is usually caused by person-to-person contact or eating or drinking something contaminated with the hepatitis virus. It is almost always mild, requiring no treatment, although in some cases, it can become life threatening. Hepatitis B is transmitted through blood and body fluids, or from mother to baby during birth. Most adults recover from hepatitis B, although a small percentage become carriers. There are safe and effective vaccines to protect against both hepatitis A and B.
Hepatitis C is the most dangerous type and can lead to life-threatening complications, including cirrhosis and scarring of the liver. It is transmitted through contaminated blood or needles, and there is no vaccine for this strain of the virus.
While not common in the United States, hepatitis D can only occur among individuals who have already been infected with hepatitis B. There is no vaccine for hepatitis D, but it can be prevented in persons who are not already infected with hepatitis B by getting the hepatitis B vaccination.
Finally, hepatitis E is a self-limited disease transmitted from ingestion of fecal matter, even in microscopic amounts, and is usually associated with contaminated water supply in countries with poor sanitation. There is currently no FDA-approved vaccine for Hepatitis E.
What hepatitis treatment does Medicare cover?
Original Medicare, Part A and Part B, covers certain tests and treatments for hepatitis infections. If you are admitted to the hospital for treatment of hepatitis, Medicare Part A pays for covered services, supplies, and prescription medications that are medically necessary to treat your condition; you’ll be responsible for any deductible and/or coinsurance costs that are part of your share. If you meet eligibility criteria, Part A also covers hepatitis treatment in a skilled nursing facility, as well as hospice care for those with advanced stages of the disease.
If you receive treatment for hepatitis in your doctor’s office or at an outpatient facility, your care is covered under Medicare Part B. This includes doctor visits, lab tests, X-rays, and other medically necessary services your doctor may order for you. Depending on the service, you may need to pay the Part B deductible, a copayment, and/or coinsurance.
Part B covers some hepatitis screenings and vaccines at no cost to you if administered by a provider who accepts Medicare assignment:*
- One hepatitis C screening test
- Annual hepatitis C screenings for high-risk individuals with a past or current history of IV drug use; those who received a blood transfusion before 1992; or those born between 1945to 1965.
- Hepatitis B vaccine series if you have conditions (such as hemophilia, end-stage renal disease, diabetes) or other factors that put you at high or medium risk for the virus
*You’re only covered for the hepatitis C screenings if these tests are ordered for you by your primary care doctor or practitioner.
Most people with hepatitis require regular monitoring of their condition by a health-care provider, including special blood tests, in order to detect any potential liver problems; some may also require short or long-term prescription drug therapy. If you need prescription drug coverage and have Original Medicare, you can get this through a stand-alone Medicare Prescription Drug Plan.
If you are enrolled in a Medicare Advantage plan, your hepatitis treatment is also covered, since these plans offer at least the same coverage as Original Medicare, except for hospice care, which is still covered under Part A. Medicare Advantage plans may have different costs, such as lower copayments and a cap on out-of-pocket costs; most also offer prescription drug benefits.
Where can I get more information?
A hepatitis diagnosis can be frightening, especially if you are concerned about the health-care costs for your treatment. I’m happy to discuss Medicare plan options that meet your health needs; click on the “View profile” link below to learn more about me. You can also arrange a time for me to call you, or request a personalized email by clicking on the corresponding buttons below. You can view information about plans you may be eligible for now by clicking the Compare Plans button.
To learn more about hepatitis, see:
World Health Organization, “What is hepatitis?” last updated July 2015, http://www.who.int/features/qa/76/en/
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