What Does Medicare Cover for Hepatitis C?

Medicare divides its services into different parts, including parts A, B, C, and D. Each part is responsible for paying for your medically necessary services and items.

Here are some ways that your Medicare coverage may pay for costs related to hepatitis C.

Part A

Medicare Part A covers hospital and inpatient-related services. This portion would pay for costs if you require hospitalization related to your hepatitis C.

Part B

Medicare Part B covers outpatient medical costs. These include:

• doctor’s office visits
• preventive care
• durable medical equipment

This means Part B would pay for doctor’s visits related to your hepatitis C and screenings to test for the virus.

However, Medicare covers the costs of the preventive screenings only if you’re considered “high risk.” If you don’t meet the criteria for a screening or need a hepatitis C test more than once per year, you may have to pay some of the costs.

Part C

Medicare Part C is also known as Medicare Advantage. This is a combination Medicare plan where a private insurance company provides your Medicare benefits.

Medicare requires that all Advantage plans cover at least the same benefits as original Medicare (parts A and B). Often, they also include Part D (prescription drug) coverage.

This means you’ll still get coverage for preventive screenings, hospital stays, and doctor’s visits, as well as medications as long as you have prescription drug coverage through your plan.

Part D

Medicare Part D covers prescription drugs. A variety of Part D plans are available through many private insurance companies. Each company has a list of medications it covers, called a formulary.

As of July 2015, Medicare requires all Part D formularies to cover at least one medication that treats hepatitis C. This doesn’t mean the medications have a low cost, however.

Many plans will require you to get authorization from your doctor before beginning treatments. You’ll also pay a coinsurance cost for the medication; this can vary by plan.

Medigap

Medigap, or Medicare supplement insurance, is a plan that helps you reduce out-of-pocket costs if you have original Medicare.

While there are different plans available, they generally help pay for costs like coinsurance and premiums for parts A and B, as well as foreign travel emergency care and more.

Having a Medigap policy may help reduce your out-of-pocket costs if you require care for hepatitis C. However, Medigap doesn’t offer specific coverages for medications or testing.

The following are some aspects of care for detecting and treating hepatitis C that Medicare may cover.

Medications

Medicare requires that all individuals who are eligible for Medicare have a Part D plan or other creditable prescription drug coverage. These plans will usually have a formulary that separates drugs into different tiers based on cost.

One of the most expensive tiers is called the specialty tier. Some of these drugs may cost more than $600 a month.

Drugs to treat hepatitis C often fall under the specialty category, which means they can be expensive even with coverage.

Screenings

Medicare will cover screening tests for hepatitis C if you:

• have a history of using injectable drugs
• were born between the years 1945 and 1965
• were the recipient of a blood transfusion before the year 1992

If you’re at high risk for contracting hepatitis C — such as if you continue to use injectable drugs — Medicare will cover a yearly screening for hepatitis C. However, you must get the screening test from a medical provider who is enrolled in Medicare and accepts assignment.

Researchers have consistently produced new antiviral medications to treat hepatitis C. Some may be too new for Medicare plans to cover them.

For example, Medicare plans don’t yet cover the medications Zepatier (elbasvir and grazoprevir) and Peginterferon (peg interferon alfa-2b).

The FDA has currently approved seven medications to treat hepatitis C. However, not all of these will appear on a plan’s Part D formulary. Often, only one medication appears on a plan’s list. As a result, your doctor may prescribe medications to you based on what your plan covers.

Of course, not all hepatitis C medications are the same. Some require that you take them for an extended time period — even up to nearly a year. Some are more convenient to take, have fewer side effects, or are more researched in terms of their risks and benefits.

If your doctor feels that you need a different medication than the one covered by your plan, they may be able to write a letter to Medicare or your Medicare Advantage provider and ask for an exemption for your particular case.

Even with Medicare coverage, medication treatments for hepatitis C can still be costly. According to a 2017 analysis, the cost could range from $6,297 to $10,889 for the entire treatment course.

Depending on your income, you may be able to qualify for a low-income subsidy. This means you’d get assistance to pay for your medication costs. According to the same analysis, Medicare beneficiaries with a low-income subsidy paid between $10.80 and $1,191 for their total hepatitis C treatment costs.

Several FDA-approved medications can treat hepatitis C. The following are some commonly prescribed medications that Medicare plans cover, as well as their estimated costs according to GoodRx.com.

Cost is certainly a factor to consider in your hepatitis C treatment. However, complications from hepatitis C can be life threatening. Ideally, you and your doctor can find a treatment plan that will be affordable, safe, and effective for you.

Hepatitis C is a virus that can cause a long-term infection in the body that especially affects the liver. Some people are exposed to hepatitis C and the body clears the infection on its own. Other people can experience an acute illness and lifelong infection that leads to liver complications.

According to the Centers for Disease Control and Prevention (CDC), an estimated 2.4 million people in the United States lived with hepatitis C in 2016.

Currently, no vaccine can prevent hepatitis C transmission. However, you can take medications to treat the virus that causes hepatitis C.

Unfortunately, even if you’ve had hepatitis C in the past and have had successful treatments, you can get the virus again. Avoid practices that could lead to hepatitis C transmission, including:

• going to unlicensed or unregulated tattoo and body piercing sites
• having sex without the use of a barrier method
• not using safety precautions when handling medical supplies and equipment that have been exposed to blood
• sharing personal items — such as a razor, toothbrush, or glucose monitor — that could’ve come in contact with the blood of a person who has hepatitis C
• sharing needles or other drug-related items or equipment

If your doctor diagnoses you with hepatitis C, they’ll usually recommend you take certain medications. You’ll typically take these for about 8 to 12 weeks.

The treatment success rate is often high: In about 90 percent of people who take hepatitis C medications, the condition is cured.

• Medicare covers screenings to detect hepatitis C, often at no cost.
• Medicare Part D plans must include at least one hepatitis C treatment medication.
• These prescription drugs are often still expensive if you don’t have a low-income subsidy to help pay for them.
• You can talk with your doctor about ways to save money on your prescriptions and find one that meets all your needs.