Does Medicare Cover Hepatitis Screenings & Treatments?

Hepatitis is a fairly common viral condition that you may have heard of, but not know too much about. According to the United States Department of Health & Human Services (HHS), between 3.1 million and 6.9 million people may be living with hepatitis B or C in the United States. Of those cases, more than a third (36.3 percent) involve baby boomers. Additionally, the number of hepatitis cases, especially hepatitis C, are increasing. With the virus infecting so many, it’s important to know the key facts about it, including whether or not Medicare covers hepatitis screenings and treatment!

What is Hepatitis, and How Can You Get It?

First and foremost, hepatitis is an inflammation of the liver. There are five main types of hepatitis — A, B, C, D, and E — though the most common types are A, B, and C. Hepatitis D and E are less common, with D only occurring in people infected with hepatitis B and E resulting from ingesting a contaminated product.

The other types of hepatitis have their own varying ways of spreading. Hepatitis A is spread by ingesting food or drinks that have been contaminated by the fecal matter of an infected person. As far as hepatitis B goes, it can spread by coming into contact with the blood, semen, or other bodily fluids of an infected person. Similarly, hepatitis C is spread when the blood of an infected person enters the body of an uninfected person.

Hepatitis Symptoms

Many people who have hepatitis are symptom free, unless they develop an acute infection. This generally happens two weeks to six months after the initial exposure. Symptoms can include as fever, fatigue, loss of appetite, nausea, vomiting, abdominal or joint pain, dark urine, light-colored stool, and jaundice.

Hepatitis A vs. B vs. C

The differences between the three most common forms of hepatitis matter because they define both the prevention and the treatment of each. For example, hepatitis A and B both have vaccines that can protect against infection; hepatitis C does not. Unlike the other two conditions, hepatitis A doesn’t have a specific treatment associated with it, because your body will generally clear the infection on its own with no lasting damage. Generally, you’ll just want to rest, manage your symptoms, and avoid alcohol. Depending on your type of hepatitis B, your treatment may differ.

For acute hepatitis B, you may not need treatment, much like hepatitis A. For chronic hepatitis B, your doctor will likely prescribe antiviral medications, interferon injections, or even a liver transplant if there is severe damage. For hepatitis C, your provider will likely prescribe antiviral medications. If there’s been too much damage to the liver, though, you may need a transplant.

Medicare Coverage for Hepatitis Screenings, Shots, and Treatment

There are plenty of services and treatments related to hepatitis that Medicare helps cover.

Hepatitis A Vaccine

Medicare Part D covers the hepatitis A vaccine when it’s medically necessary. Your Part D plan should cover the administration costs of the vaccine, which may include dispensing fees, ingredient costs, and even sales tax.

Hepatitis B Vaccine & Infection Screening

The coverage options for hepatitis B get a little more complex because they have certain requirements attached to them. For example, Medicare Part B may cover the hepatitis B vaccine if you’re considered medium or high risk for hepatitis B. You may fit into this category if one of the following situations applies to you:

  • You have hemophilia
  • You have End-Stage Renal Disease (ESRD)
  • You have diabetes
  • You live with someone who has hepatitis B
  • You come into frequent contact with blood or other bodily fluids because you’re a health care worker

The Centers for Medicare & Medicaid Services (CMS) note that other circumstances may qualify you for vaccine coverage. If you’re interested in the vaccine, check with your doctor to see if you fit any of the qualifying categories to receive coverage.

You may also receive coverage for a hepatitis B infection screening if you fall into that risk category or are pregnant and your doctor accepts Medicare assignment. A doctor must order the screening, and if you do qualify for it, the frequency of the screening often depends on your circumstances. If you qualified for coverage because you’re high risk, you’ll be covered for an annual test once a year as long as you remain high risk and don’t get a hepatitis B shot.

Hepatitis C Infection Screening

Hepatitis C is the most common form of hepatitis in seniors in the United States, with up to approximately 40 percent of individuals over 60 years old being infected by it. The condition can be particularly severe in seniors, especially if they don’t seek treatment for it. What makes this infection even more dangerous is that hepatitis C often appears without symptoms for many years, until there’s been enough damage in the liver to cause signs of the condition. This makes a screening for the condition all the more important to find it early.

Like hepatitis B screening, Medicare covers a screening for hepatitis C if you’re considered at high risk. To qualify for a hepatitis C screening, you must meet one the qualifying conditions below (if not multiple). If you fall into one or more of these categories, your doctor or a health care provider orders the screening, and the service provider accepts assignment, you should pay nothing for receiving the test.

  • You use or have used illegal injection drugs
  • You had a blood transfusion before 1992
  • You were born between 1945 and 1965

The first qualifier probably makes sense, but what about the other two? Before 1992, blood transfusions weren’t screened for hepatitis C, which may have led to thousands of people being infected with the illness. As for last qualifier, research into the prevalence of hepatitis C by the Centers for Disease Control and Prevention (CDC) found that three in 100 individuals born between the years of 1945 and 1965 had hepatitis C. This infection number is five times higher than other age groups. What’s more, it accounted for approximately 75 percent of the known hepatitis C cases.

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Hepatitis can be a serious illness if it’s not caught and treated — the key here being if it’s not caught. With the condition being a high risk for many of its beneficiaries, it only makes sense that Medicare would offer coverage for both screenings and vaccines when possible. With the amount of coverage you have, consider talking to your doctor about assessing your risk.