Does Medicare Cover Hepatitis C Treatment?
- Find out about which Medicare plans cover the costs of hepatitis C treatment and how much you're expected to pay out of pocket for screenings and medications.
An estimated 2.4 million people in the United States have hepatitis C, which is a viral infection that affects the liver. When untreated, it can lead to long-term health consequences, but it's curable, and people with the disease have a normal life expectancy. Read on to discover how much of hepatitis C treatment Medicare might cover and which parts are responsible for the different aspects of treatment.
Does Medicare Cover Hepatitis C Treatment?
Medicare covers hepatitis C screenings for the people who are most at-risk for developing this condition. This includes the following groups:
- People with a history of using injectable substances
- People born between 1945 and 1965
- People who received a blood transfusion before 1992
People at the highest risk, namely those who have a drug habit involving injectable drugs, can get a screening once a year with Original Medicare. Screening must be administered by a Medicare-enrolled medical provider.
When it comes to medications used to treat hepatitis C, you'll need a Medicare Part D plan. These plans come with a drug list called a formulary that defines the medications you're entitled to receive coverage for. All medications included on your formulary fall into different tiers, which are based on costs.
Many hepatitis C treatments fall into the specialty tier, which can cost up to $670 per month. Even with Medicare Part D coverage, the cost of these drugs can be very high. If you're on a low-income, you might be eligible for support to help cover the costs of hepatitis C medication.
What Is Hepatitis C?
Hepatitis C is inflammation of the liver as a result of the hepatitis C virus. It ranges in severity significantly, causing mild symptoms in some instances and leading to life-threatening cirrhosis and cancer in others. This blood-borne virus is most commonly transmitted through exposure to blood as a result of:
- Unsafe intravenous injection practices
- Unsanitary health care
- Unscreened blood transfusions
- Risky sexual behavior
- IV drug use
The incubation period ranges from between two weeks and six months, with most people not experiencing any symptoms initially. It often takes decades for symptoms to appear, which is usually when secondary liver damage is advancing. Early diagnosis is associated with positive outcomes, but even late-stage liver damage is treatable.
Which Parts of Medicare Cover Treatment for Hepatitis C?
Medicare is split into four parts to cover different types of medical treatment. Below is an explanation of how the different Medicare parts cover health care for hepatitis C.
Original Medicare includes Part A and Part B. Part A will only kick in if you require inpatient treatment for hepatitis C, and it covers all treatment and medication you receive. Medicare Part B covers any outpatient treatment you receive, including doctor visits and preventative care.
As such, if a doctor says that you need to receive screening for hepatitis C, Part B will cover it. However, if you aren't high risk and don't meet the criteria for screening, you might need to cover some or all of the costs yourself.
Medicare Part C, or Medicare Advantage, covers everything that Part A and B does but with some potential extras. This type of plan is offered by a private insurance company in partnership with Medicare, so you can choose the specific plan yourself. Some plans also include medication coverage.
Medicare Part D provides coverage for the prescription medications outlined in your formulary. All formularies must include at least one drug that treats hepatitis C, but the costs associated with the medications used for the condition are often very expensive. Coinsurance varies depending on your plan, and you'll need to cover this cost.
Medigap is supplementary insurance for Medicare, which can help you meet out-of-pocket expenses if you're a beneficiary of Original Medicare. In most cases, it's only available to help pay for premiums and coinsurance for Part A and Part B as well as other services, such as foreign travel emergencies.
What Isn't Covered?
One of the important caveats to note is that Medicare doesn't cover medications that are considered experimental. There are currently seven FDA-approved drugs, but there's a good chance you'll only see a single one on your formulary.
Your doctor can write a letter to Medicare if they think you need access to a drug that isn't included on your formulary. However, most people can expect to pay quite a lot for the medications associated with hepatitis C, unless they're eligible for a low-income subsidy.