Does Medicare Cover Hepatitis C Screenings?

Hepatitis C is a viral infection that if left untreated can cause liver cancer, liver failure or cirrhosis of the liver. It is the leading cause of serious liver conditions in the United States.

It spreads through contact with contaminated blood and there is no vaccine to protect against hepatitis C. The virus usually does not present any symptoms, so most people who have it don’t realize they’re infected for years or even decades.

Hepatitis C screenings can tell you if you have the virus and allow you to seek treatment before it causes cancer or other serious liver damage.

People born as part of the baby-boom generation have been at the greatest risk of having hepatitis C lurking in their bodies. Much of this is because of the era in which they have lived and changes in culture and medical science.

The years between 1960 and 1980 were the period of the highest transmission of hepatitis C in the United States, according to University of Iowa Health Care.

The U.S. Centers for Disease Control and Prevention set up hepatitis C testing guidelines based on risk factors. The CDC estimated that more than 3 percent of baby boomers were infected with HCV — five times higher than any other age group at the time and roughly 75 percent of all hepatitis C cases in the United States.

Medicare expanded its coverage based on those CDC guidelines.

While the opioid crisis has led to younger demographics in recent years and the CDC reports a new wave of HVC infections, hepatitis C still remains a serious, “silent” killer for Americans born from 1945 through 1965.

Original Medicare — Medicare Part A and Part B — will only cover the cost of your hepatitis C virus (HCV) screening if your primary care doctor or other primary care provider orders one and you meet one or more of three other criteria that Medicare requires.

If you meet Medicare’s requirements, it will pay the full cost of the hepatitis C screening. You will pay nothing out-of-pocket so long as the doctor or other health care provider accepts the screening’s Medicare-approved cost.

Depending on your situation, Original Medicare will cover a one-time screening or repeated hepatitis C screenings.

Your doctor or other primary care provider will determine whether you are at high risk for HCV based on your medical history. This assessment typically comes as part of your Medicare annual wellness visit and the development of the comprehensive prevention plan you and your doctor create.

Hepatitis C is treatable and can be cured with medication in most cases if it’s caught early. Waiting too long may require liver transplant.

While there is no hepatitis C vaccine, your doctor may recommend vaccinations against hepatitis A and hepatitis B. These are other viruses that can also cause liver damage as well as complicating your case of hepatitis C.