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Hepatitis B and Hepatitis C Medicare Coverage

Hepatitis B
Hepatitis B is a viral infection that attacks the liver and can cause both acute and chronic diseases. The virus is most commonly transmitted from mother to child during birth and delivery, as well as through contact with blood or other body fluids. It can be prevented by vaccines that are safe, available, and effective.
Eligibility
Medicare Part B covers the hepatitis B vaccine if you are at medium or high risk for hepatitis B. Medicare considers you at medium or high risk if you:
  • Have End-Stage Renal Disease (ESRD)
  • Have hemophilia
  • Live in the same household as a hepatitis B carrier
  • Have unprotected sex with multiple partners or with someone who has hepatitis B
  • Use certain federally prohibited substances
  • Are health care professional in frequent contact with blood or other body fluids during routine work
Note: If you are at low risk for hepatitis B, the shot will be covered under Part D.

Hepatitis C

Hepatitis C is a liver disease caused by the hepatitis C virus (HCV). The virus can cause both acute and chronic hepatitis, ranging in severity from a mild illness lasting a few weeks to a serious, lifelong illness. Hepatitis C is a major cause of liver cancer. The hepatitis C virus is a bloodborne virus and the most common modes of infection are through exposure to small quantities of blood. This may happen through injection drug use, unsafe injection practices, unsafe health care, transfusion of unscreened blood and blood products, and sexual practices that lead to exposure to blood.

Eligibility
Medicare Part B covers one hepatitis C screening if your primary care provider (PCP) orders the test for you, and you:
  • Were born between 1945 and 1965
  • Had a blood transfusion before 1992
  • Or, are considered high risk due to current or past history using federally prohibited, injectable substances
Note: If you are considered at high risk for hepatitis C, you also qualify for yearly screenings following the initial screening.

Costs for both Hepa B and C Coverage
If you qualify, Original Medicare covers hepatitis B shots at 100% of the Medicare-approved amount when you receive the service from a participating provider. This means you pay nothing, no deductible or coinsurance. 
Medicare Advantage Plans are required to cover hepatitis B shots without applying deductibles, copayments, or coinsurance when you see an in-network provider and meet Medicare’s eligibility requirements for the service.
During the course of your hepatitis B shot, your provider may discover and need to investigate or treat a new or existing problem. This additional care is considered diagnostic, meaning your provider is treating you because of certain symptoms or risk factors. Medicare may bill you for any diagnostic care you receive during a preventive visit.

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