Does Medicare Cover Hep C Testing?

Does Medicare Cover Hep C Testing?

Hepatitis C rarely causes symptoms in the early stages. Screening tests help save lives.

Many people with hepatitis C don’t know they have it because symptoms can take decades to appear. That’s why the U.S. Preventive Services Task Force recommends all adults through age 79 be screened, even if you don’t have symptoms. Therefore, it’s important for Medicare beneficiaries to understand coverage for hep C testing, as well as treatment options and coverage.

What is hepatitis C?

Hepatitis C is a viral infection that can cause liver swelling, which can lead to serious liver damage. The virus spreads through contact with blood that has the virus in it.

Long-term hep C infections start with what’s called an “acute phase,” typically not diagnosed early on because it rarely causes symptoms. Then, long-term infection is called chronic hepatitis C.

Note that acute hep C doesn’t always become chronic. Sometimes, people can clear the infection from their bodies after the acute phase, called spontaneous viral clearance. Or, antiviral therapy can help clear it.

Hep C infection that continues over many years can cause serious complications like scarring of the liver (cirrhosis), liver cancer, and liver failure.

Symptoms of hepatitis C

If hep C in the acute phase causes symptoms, you could experience fatigue, nausea, fever, muscle aches, and jaundice.

Chronic hep C may also not have symptoms for many years as they only appear when the virus causes enough liver damage. Eventually, symptoms can include bleeding and bruising easily, fatigue, jaundice of the skin, itchy skin, fluid buildup in the stomach area, lack of appetite, weight loss, swelling in the legs, confusion, drowsiness, and dark-colored urine.

Are older people at risk for hepatitis C?

People born between the years of 1945 and 1965 are at the highest risk of hep C because the years between 1960 and 1980 were the highest transmission periods. This is believed to be due to less advanced surgical sterilization procedures, spread through transfusion and transplants due to lack of widespread blood supply screening, and the increase in recreational drug use.

What is a hepatitis C screening test?

A hepatitis C screening, called an HVC antibody test or anti-HVC test, looks for antibodies to the hepatitis C virus in your blood. Your doctor will take a sample of your blood to look for these antibodies. Results can take a few days or a few weeks to come back, though rapid anti-HCV tests are available in some clinics.

A non-reactive or negative antibody test means you’re not currently infected with hep C. However, if you think you may have been exposed in the last six months, you will need to be tested again.

A reactive or positive antibody test may require additional testing to ensure you have hep C, called a nucleic acid test (NAT) for HCV RNA. If it’s negative, you were infected with hep C but the virus is no longer in your body. If it’s positive, you have the virus in your blood.

Should you have a reactive antibody test and positive NAT for HCV RNA, talk to your doctor about your treatment options.

Medicare coverage for hepatitis C testing

Medicare Part B covers a Hepatitis C screening test if your primary care provider (PCP) or other healthcare provider orders one, and you are at high risk because you were born between 1945 and 1965, you use or have used illicit injection drugs, or you had a blood transfusion before 1992.

If you were born between 1945 and 1965 and aren’t considered high risk, Medicare will pay for one hepatitis C screening.

If you are considered high risk, Medicare covers yearly screenings.

Medicare coverage for hepatitis C treatment

Hepatitis C is treatable, and in many cases can be cured, as long as it’s caught early.

Medicare Part D prescription drug plans are required to cover at least one hepatitis C antiviral drug, though in some cases, they are still expensive. Treatment can take up to three months or more, but most have a high success rate. Check your plan’s formulary to learn which hep C drugs may be covered.

While new antiviral medications to treat hepatitis C are regularly being produced, Medicare plans don’t yet cover all of them. Your provider may prescribe medication based on what your plan covers but know that not all medications are the same so if your provider feels you need a different medication than the one covered by your plan, they may write to Medicare (or your Medicare Advantage plan) to ask for an exemption.

If your hepatitis C is not detected until it’s caused more damage, you may require a liver transplant. Medicare Part A and Part B will cover many of your transplant costs, but you’ll still be required to pay the Part A and B deductibles out-of-pocket ($1,600 per benefit period and $226 per year) and you may have other co-pay and co-insurance costs.

Also note that even if you have a liver transplant, you’ll likely still need antiviral drug treatment to prevent damage to your new liver.

Should you require hospitalization related to your hepatitis C, these inpatient services would be covered by Part A.

Other doctor’s office visits and other outpatient services may be covered by Part B.

How much does hepatitis C testing cost?

If you qualify, Original Medicare will cover 100% of the cost of a hepatitis C screening. The Part B deductible does not apply.

If you have a Medicare Advantage plan, you will also pay $0 for this screening as long as you see an in-network provider and meet the eligibility requirements.

Additional resources

After retiring from a career as an executive travel counselor in 2006, Donna Frederick embarked on a second career as a licensed insurance agent. During that first year, many clients told Donna how overwhelmed they felt by Medicare, but that her assistance helped them finally understand the Medicare program. That experience inspired Donna to focus her efforts on educating her clients to ensure they fully understand their Medicare options. Today, Donna takes pride in providing outstanding customer service and going the extra mile to make sure each client knows all of their options and has a sound understanding of their Medicare plan, from costs to coverage and all points in between.


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