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Medicare Hepatitis C Screening Coverage

Written by:
Rachael Zimlich, RN, BSN
Eboni Onayo
Reviewed by:
Eboni Onayo

Key Takeaways

  • Medicare will cover the screening for Hepatitis C.
  • In order to qualify for coverage, you may need to have at least one high-risk condition.
  • If you qualify for coverage, the screening will be completely free under Medicare Part B’s coverage of preventive care services.
  • Make sure that your doctor or the provider performing the screening participates in the Medicare program.

Hepatitis C is a liver disease that is passed through the blood. It’s often transmitted from one person to another, usually through contact with an infected person’s blood. This can also happen indirectly, with the virus commonly passed from infected people to others by sharing instruments used for injectable drugs.

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How Much Does Hep C Screening Cost?

Hepatitis screening costs vary depending on where the test is performed. Typically, the cost of a Hepatitis C test will start at around $50. Additional laboratory fees may be added, so the total cost will depend on your specific test and where it’s performed.

Does Medicare Pay for Hepatitis Panel Blood Test?

Medicare will cover the cost of a Hepatitis C screening panel if you have certain risk factors.

Universal screening has been debated to catch those chronic cases that have no symptoms, but the cost of offering screening to everyone would be very high.

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How Do You Get Tested for Hep C?

Hepatitis C is tested with a blood test that measures antibodies to the virus. When you get tested, a lab technician will draw some bleed from a vein with a small needle, and the blood sample will be tested for antibodies to the Hepatitis C virus.

Once you’ve been infected with the Hepatitis C virus, you will always have antibodies in your blood. While the antibodies will always be in your body, it may be confusing to understand your test results.

  • If your test comes back non-reactive, or as a negative antibody result, this means that you don’t have a current, active infection from the virus. However, if you suspect you may have been infected with the virus at some point in the last six months, a repeat test is recommended.
  • A reactive test, or positive antibody result, means that you were infected with Hepatitis C at some point, but you might not have a current, active infection.

Does Medicare Cover Hepatitis C Treatment?

Medicare will generally cover any treatments your doctor considered medically necessary. What portion of Medicare covers these treatments may vary. Inpatient treatments are covered under Medicare Part A, while outpatient treatments and therapies are covered by Medicare Part B. Medications, like the oral antiviral medications used to treat Hepatitis C, are covered by Medicare’s prescription drug plan, Medicare Part D. If you choose not to enroll in Medicare Part D, you will have to pay the full cost of these medications yourself.

Who Should Get a Hep C screening?

There are certain risk factors that increase your risk of becoming infected with the Hepatitis C virus. These include:

  • If you use or have used injected illicit drugs
  • If you received a blood transfusion before 1992
  • If you were born between 1945 and 1965
Usually, a screening is recommended if you meet one or more of these risk factors, but your doctor may also suggest you be screened for other reasons. Hepatitis C can be a short-term acute infection or a chronic disease. In many cases of chronic disease, there are few or no symptoms, so the condition can go undetected for some time.

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FAQs

Medicare doesn’t cover Hepatitis C screening for everyone, but it will if you meet certain risk factors. These include intravenous drug use, a history of receiving blood transfusions before 1992, and certain age groups.
Medicare generally covers anything your doctor orders as medically necessary. Medicare Part D will cover the cost of the oral antiviral medications you will need to manage Hepatitis C if you are enrolled in the program. If you opt-out of Medicare Part D, you will pay the full cost of these medications.
If you meet one or more of the high-risk criteria, your doctor will likely order a Hepatitis C screening for you. You can also undergo testing at retail pharmacies, but Medicare coverage at these facilities may be limited. In order for Medicare to cover Hepatitis C screening and treatment, your provider must participate in the Medicare program.

Sources

This website is operated by GoHealth, LLC., a licensed health insurance company. The website and its contents are for informational and educational purposes; helping people understand Medicare in a simple way. The purpose of this website is the solicitation of insurance. Contact will be made by a licensed insurance agent/producer or insurance company. Medicare Supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program. Our mission is to help every American get better health insurance and save money.

Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.