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Does Medicare Cover Hepatitis C Screening

If Using The General Medical Consent Does The Hepatitis C Screening Test Have To Be Specifically Listed In The Consent Language

Module 3 Hepatitis C Epidemiology, Testing, Diagnosis, and Treatment

No. The hepatitis C screening test does not specifically need to be identified in the consent language. However, we do recommend that the patient receives some type of education on hepatitis C, including the rationale for the screening test. The educational information can be provided in many different formats, including a fact sheet, brochure or a poster.

Medicare Coverage For Hepatitis Screenings Vaccines And Treatments

Home / FAQs / Medicare Coverage / Medicare Coverage for Hepatitis Screenings, Vaccines, and Treatme

Viral hepatitis is a condition that inflames the liver. Its contagious and causes over a million deaths each year. Fortunately, Medicare helps to protect recipients from hepatitis. But what do they pay for? Well go over which preventions and treatments for Hepatitis A, B, and C obtain coverage.

Hepatitis B Vaccine & Infection Screening

The coverage options for hepatitis B get a little more complex because they have certain requirements attached to them. For example, Medicare Part B may cover the hepatitis B vaccine if youre considered medium or high risk for hepatitis B. You may fit into this category if one of the following situations applies to you:

  • You have hemophilia

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What Are The Possible Side Effects Of Hepatitis A Immunisation

All medicines and vaccines can have side effects. Sometimes they are serious, most of the time theyre not.

For most people, the chance of having a serious side effect from a vaccine is much lower than the chance of serious harm if you caught the disease.

Talk to your doctor about possible side effects of hepatitis A vaccines, or if you or your child have possible side effects that worry you.

Common side effects of hepatitis A vaccines include:

  • headache
  • pain where the needle went in.

Does Medicare Cover Hepatitis Screenings & Treatments

What Routine Blood Tests Does Medicare Cover ...

Hepatitis is a fairly common viral condition that you may have heard of, but not know too much about. According to the United States Department of Health & Human Services , between 3.1 million and 6.9 million people may be living with hepatitis B or C in the United States. Of those cases, more than a third involve baby boomers. Additionally, the number of hepatitis cases, especially hepatitis C, are increasing. With the virus infecting so many, its important to know the key facts about it, including whether or not Medicare covers hepatitis screenings and treatment!

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How Do Patients Decline Testing And What Documentation Is Required

Patients always have the option to decline testing. They may do so orally or in writing. There is no requirement for formal documentation of the declination. However, a notation in the patientâs medical record of the offering of the test and the patientâs declination may help keep track of those patients that have already been offered the test.

How Does Medicare Cover Hepatitis Screenings

Hepatitis C is a viral infection that can lead to serious liver damage if untreated. Medicare Part B may cover one-time Hep C testing for patients who are at high risk of contracting the virus.

You are considered high risk if you meet one or more of the following criteria:

  • You use or have used illicit injected drugs
  • You had a blood transfusion earlier than 1992
  • You were born between 1945-1965

If you are considered at risk for Hep C, Medicare Part B will also cover yearly screenings to check on your health compared to your initial Hep C test.

Medicare Part B may also cover Hepatitis B Virus screening if youre at high risk for HBV or if youre pregnant.

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Do I Have To Pay For Vaccines With Medicare

You pay nothing for vaccines covered by Part B flu, pneumonia and Hepatitis B as long as your provider accepts Medicare.

Your cost for vaccines covered by Part D will depend on your specific plan. You may pay a copay or coinsurance, but it will depend on your plan and the provider.

The location where you get vaccinated may also affect your cost. For example, your costs may be lower if you get a vaccine at a pharmacy versus in a doctors office.

Why Is It Important To Test Persons Born Between 1945 And 1965

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  • According to the Centers for Disease Control and Prevention , more than 75% of adults infected with hepatitis C are people born from 1945 through 1965 .
  • The reason that baby boomers have high rates of hepatitis C is not completely understood. However, it is believed that most baby boomers became infected in the 1970’s and 1980’s when rates of hepatitis C and drug use were highest. Since people with hepatitis C can live for decades without symptoms, many baby boomers are unknowingly living with an infection they got many years ago that can lead to liver disease, liver failure and cancer.
  • Hepatitis C is primarily spread through contact with blood from an infected person. Many baby boomers could have gotten infected from contaminated blood and blood products before widespread screening of the blood supply began in 1992 and universal precautions were adopted. Still, many baby boomers do not know or remember how or when they were infected.

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Does Medicare Cover Other Types Of Hepatitis Vaccinations

There are five different types of hepatitis . There are vaccinations available only for hepatitis A and hepatitis B.

While Medicare covers hepatitis B vaccinations, it does not cover hepatitis A vaccinations.

Hepatitis B and C are the most common types of hepatitis. There is no vaccination against hepatitis C, but Medicare does cover screening for hepatitis C.

Will Medicare Help Cover Hepatitis A Vaccine

Fortunately, Medicare covers the costs of vaccines for hepatitis A. Generally, Medicare Part D that pertains to prescription drugs covers Hepatitis A vaccines when it is deemed medically necessary.

However, it should be noted that Medicare Part A and B do not cover the vaccines for Hepatitis A. The costs of this vaccine would be reimbursed only when it is recommended for patients who are at a higher risk of contracting the infection and more serious complications related to the same.

Some examples of conditions that can increase the risk for hepatitis include a very low immunity due to conditions such as HIV/AIDS and long-term use of steroidal drugs.

Health care workers, as well as people in prisons or living in group homes or institutionalized facilities, are also considered to have a higher risk for hepatitis. The cost of the vaccines for hepatitis A and B would be covered by Medicare part B for patients who fall into these categories.

However, to be eligible for the coverage, certain criteria must be fulfilled. The doctor recommending it must accept Medicare assignments to receive the coverage benefits.

It should be noted that hepatitis A vaccine can help you avoid the risk of hepatic complications associated with liver damage. It can also prevent serious symptoms that can occur in case you are infected with this virus. Hence, patients are advised to receive hepatitis A vaccine to protect themselves of the symptoms and long-term consequences of this disease.

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Medicare Preventive Service Visit Vs Routine Physical

The preventive exam doesnt include physical tests such as lung exams and reflexes. But, if there is a symptom that necessitates that kind of screening, Medicare will cover it. Medicare doesnt cover routine physicals. Youll pay 100% of the costs for a routine physical.

The average cost of a routine physical without insurance ranges from $50- $200, although the costs could be more.

Medicares Preventative Care Service Checklist

Medicare Will Cover Hepatitis C Screening in Primary Care ...

Every five years, Medicare covers cardiovascular screening blood tests. The blood tests help detect conditions that would lead to a stroke or heart attack.

During your cardiovascular screening, your doctor might:

  • Check for high blood pressure
  • Offer counseling to help create a healthy diet
  • Advice on the benefits of the use of aspirin if youre in a particular age range

Part B benefits will cover cardiovascular disease risk screening annually. Medicare covers the full cost if its with a participating provider.

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Human Immunodeficiency Virus Screening

Part B covers a Human Immunodeficiency Virus screening once a year if youre between the ages of 15-65 or you have an increased risk. If youre pregnant, you can have the screening up to 3 times during your pregnancy.

High-Risk Factors Include:

  • Men that had sex with men after 1975
  • Women and Men having unprotected sex with multiple partners
  • past or present injection drug use
  • People with previous or current partners that were HIV-infected, bisexual, or injection drug users
  • Women or Men that exchange sex for money or drugs or who have partners that have
  • History of blood transfusion between 1978 and 1985
  • Individuals being treated for STDs
  • Individuals requesting an HIV test despite reporting no risk factor

As long as the doctor accepts Medicare Assignment, youll pay nothing for the annual exam.

Does Medicare Cover Other Annual Tests

There are many other tests covered by Medicare in addition to blood tests. Depending on qualifying criteria, you may pay nothing for these tests.

Some of the additional tests covered by Medicare include:

  • Mammograms for breast cancer
  • Pap smears for cervical cancer
  • Bone density tests for osteoporosis
  • Stool tests, enemas, colonoscopies and flexible sigmoidoscopies for colon cancer
  • Abdominal ultrasounds for aortic aneurysms
  • Low dose computed tomography for lung cancer
  • Eye tests for glaucoma

Medicare also covers screenings for alcohol and substance abuse and obesity.

Once a year, beneficiaries are covered for an annual wellness visit. The visit does not include any blood tests but does feature other tests and screenings for various health issues.

Medicare Advantage plans must cover at least the same tests as Original Medicare, and some plans may also cover additional tests. Check with your plan carrier directly to find out if your blood tests will be covered.

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What Are The Key Provisions Of The Law

  • A hepatitis C screening test must be offered to every individual born between 1945 and 1965 receiving health services as an inpatient or a hospital, or receiving primary care services in the outpatient department of hospital, or in a freestanding diagnostic and treatment center or from a physician, physician assistant, or nurse practitioner providing primary care.
  • If an individual accepts the offer of the hepatitis C screening test and the screening test is reactive, the health care provider must offer the individual follow-up health care or refer the individual to a health care provider who can provide follow-up health care. The follow-up health care must include a hepatitis C diagnostic test.
  • The offer of testing must be culturally and linguistically appropriate.

What Is Hepatitis C

Medicare Preventive & Screening Services

According to the National Institutes of Health, hepatitis C is inflammation in the liver caused by a virus. Some people might respond well to hepatitis C treatment, but many people dont, and can have the disease for years.

The Centers for Disease Control reports that there is currently no vaccine available to prevent hepatitis C.

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Blood Sugar Test Strips

The same way glucose monitors are Part B Durable Medical Equipment, the blood sugar test strips fall into the same category. Youll pay 20% of the costs if you dont have Medigap coverage. Those with a Medicare Advantage plan could pay a different amount. Each Advantage plan is different, consult your policy about your coverage.

You must always use a doctor AND supplier that participate in Medicare.

Sexually Transmitted Infections Screening And Counseling

Medicare covers Sexually Transmitted Infection screenings once a year if you get a referral from your doctor. Your doctor can determine if youre at high-risk for STIs while at your appointment.

Part B will cover screening for gonorrhea, chlamydia, syphilis, and hepatitis B if youre:

  • At high-risk

Medicare will cover screenings for gonorrhea and chlamydia:

  • Once a year, if youre a woman with risk
  • Youre pregnant and younger than 24
  • If youre pregnant and are at high-risk

Medicare will cover syphilis tests:

  • Once a year, if at risk
  • If youre pregnant

Medicare covers STI screenings at 100%. Medicare also covers up to 2 individual 20 to 30 minute, face-to-face, high-intensity behavioral counseling sessions each year for sexually active adults.

Provided the counseling sessions are administered by a primary care doctor and take place in a primary care setting, such as a doctors office, Medicare will cover these counseling sessions.

If the counseling session is in an inpatient setting, the sessions wont have coverage as Medicare Preventative Services.

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What To Expect From A Hepatitis B Vaccination

The hepatitis B vaccine is considered one of the safest vaccinations available with more than 1 billion hepatitis B vaccinations given since the first one was introduced. Its also considered the first anti-cancer vaccine since it can prevent liver cancer caused by the hepatitis B virus.

There are multiple brands of hepatitis B vaccines. These are typically delivered in a three-dose schedule, but a recent version of the vaccine is delivered in just two shots.

Three-Dose Schedule for Hepatitis B Vaccinations in Adults

First Shot
You should wait at least 28 days after your first shot.
Third Shot
You should wait at least 16 weeks after your first shot and at least eight weeks after your second shot.

In 2017, the U.S. Food and Drug Administration approved a new hepatitis B vaccine for adults 18 and older which requires only two shots. The brand name is Heplisav-B and the two doses are given one month apart.

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Will Nysdoh Require Any Data To Be Reported From Health Care Facilities Or Private Practitioners With Regard To Activities Mandated Under This Law

What Does Medicare Cover?

No. There are no new reporting requirements included in the Law. However, reporting of acute and chronic hepatitis C cases is mandated under the New York State Sanitary Code . Cases are required to be reported to the local health department in the county where the patient resides.

For questions on cases residing outside of NYC, call NYSDOH at 518-473-4439 or go to:

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Paying For Medicare Vaccine Coverage

Low-income beneficiaries can receive federal assistance for out-of-pocket prescription drug coverage â and vaccinations by proxy â through the Extra Help program. The Extra Help program is only available to beneficiaries with a Medicare Part D prescription drug plan. It is not available to beneficiaries with a Medicare Advantage Prescription Drug plan.

What Type Of Information Should I Provide A Patient With A Reactive Hepatitis C Screening Test

  • Explain the meaning of the reactive antibody test and counsel on the need for diagnostic testing to confirm a diagnosis of chronic hepatitis C.
  • Explain that the patient is most likely chronically infected and provide basic hepatitis C disease and treatment information.
  • Discuss the importance of minimizing risk behaviors to avoid transmitting hepatitis C infection to others, and encourage notification and screening of needle sharing and sexual partners.
  • Discuss healthy liver practices, including stopping or reducing alcohol intake and getting vaccinated against hepatitis A and B, if appropriate.
  • Encourage the patient to make these healthy choices, and describe the importance of regular medical care.

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Obesity Screening And Counseling

Body Mass Index screenings can help you lose weight if your BMI is high. Part B covers both Body Mass Index screens and counseling to help you lose weight if youre obese. What constitutes obesity? Well, if you have a BMI of 30 or more. When your doctor determines that youre overweight, youll qualify for therapy to help lead you to a better diet and proper exercise.

Medicare will cover a range of appointments for behavioral counseling:

  • One in-person visit once a week for your first month
  • One in-person visit every other week between months 2-6
  • Also, one in-person visit each month between months 7-12 This is conditional on if you can lose up to 6.6 lbs within the first six months

After your initial six months of treatment, youll go through another screening for obesity. During this, your physician will decide how much weight youve lost following your first screen.

To qualify for further in-person appointments with your physician throughout months 7-12 of therapy, youll need to lose a minimum of 6.6 lbs during your first six months of treatment.

If you dont lose at least 6.6 pounds in the first six months of your visits, your therapy could end. Your doctor can check you for another obesity test after another six months passes.

Beneficiaries have 100% coverage through Medicare.

Medicare covers diabetic screenings when youre at risk for the disease. The testing could incorporate a fasting blood glucose test and a post-glucose test.

  • Obesity

How To Get Help With Medicare Coverage For Hepatitis

Diagnosis of Management of Hepatitis C – Steven-Huy Han, MD | UCLA Primary Care Update 2015

As you can see, many parts of Medicare offer coverage for the prevention and treatment of hepatitis. We know this is difficult, and were here to help ensure youre informed and have the right coverage.

When it comes to having the best prescription drug coverage, our agents are here for you. Call the number above to speak to an agent about plans in your area. Or, fill out our online rates form to see a plan comparison and help you choose the right fit for your health and budget needs.

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