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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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Medicare Part D Costs for 2020

Before 2006, Medicare did not cover prescription medications. There was a limited number of medications that were offered under Medicare Part Band,  and otherwise, you had to pay for your medications out of pocket. In 2003, everything had changed when President George W. Bush passed the Medicare Prescription Drug, Improvement, and Modernization Act (MMA). This is what we now know of as  Medicare Part D , an optional part of Medicare that provides prescription drug coverage. Part D plans are run by private insurance companies and not by the government. However, the federal government sets guidelines on what basic medications are covered and how much you can be charged.  A deductible is the amount of money you spend out of pocket before your prescription drug benefits begin. Your plan may or may not have a deductible. The maximum deductible a plan can charge for 2020 is set at $435. It has increased by  $20 from 2019. Part D
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Benefit Period

The benefit period is the length of time during which a benefit is paid. It   measures your use of  inpatient  hospital and  skilled nursing facility (SNF)  services. This  begins the day you are admitted as an inpatient, or to an SNF, and ends the day you have been out of the hospital or SNF for 60 days in a row. After you meet your  deductible ,  Original  Medicare  will pay in full for days 1 to 60 that you are in a hospital. The remaining days, 61-90 , you will have to pay a  daily coinsurance. If your 90 days of hospital coverage has been consumed but you need to stay longer, Medicare covers up to 60 additional lifetime reserve days and yo u will also have to pay a daily  coinsurance . These days are nonrenewable , meaning you will not get them back when you become eligible for another benefit period. If you run out of days during your benefit period, Medicare will stop paying for your in-patient related hospital costs such as room and board.  To be eligible for a new b
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Comparing Health Care Providers

How do I compare the quality fo Health Care Providers? Medicare collects information about the quality and safety of medical care and services given by most health care providers (and facilities). Check Medicare.gov/quality-care-finder and get a snapshot of the quality of care they give their patients. Some feature a star rating system to help you compare quality measures that are important to you. Find out more by: Talking to your health care provider. Each health care provider should have someone you can talk to about quality. Asking your doctor or other health care provider what he or she thinks about the quality of care other providers give. You can also ask your doctor or other health care provider about the quality of care information you find on Medicare.gov . Having access to quality and cost information upfront helps you get a complete picture of your health care options. You'll be able to compare quality ratings, cost information, and other details to hel
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