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does Medicare cover Hepatitis C screening

Does Medicare Cover Hepatitis C Screening?

There are multiple types of hepatitis. One of them is known as hepatitis C. Transmission of hepatitis C virus occurs through direct contact with bodily fluids. As is the case with many illnesses, it can be traced through a medical test. 

If you are concerned about having Hepatitis C and are wanting to get a test, you may be wondering “does Medicare cover hepatitis C screening?” In this article, we answer that question in clear, plain English. You will also find the average costs of a hepatitis C screening if you have to pay for it out of pocket.

Does Medicare Cover Hepatitis C Screening?

The short answer is yes. Medicare will cover the cost of hepatitis C virus screening. But not 100% of the time. As is often the case with Medicare, certain conditions have to be met in order for Medicare to pay for your hepatitis C virus screening. Below we look at what these are so you know what to expect.

Original Medicare

Original Medicare (Medicare Part A and Part B) provides coverage for a hepatitis C virus screening. Parts A and/or B provide coverage for your hepatitis C virus screening if it is considered medically necessary. The operation must also be first ordered by your healthcare provider for Original Medicare to provide coverage.

Coverage for hepatitis C screenings is provided by Medicare Part A if it takes place in an inpatient setting such as a hospital or a skilled nursing facility. 

Most of the time, coverage for the screening is provided by Medicare Part B. However, Medicare Part B will only provide coverage for a screening under certain conditions. These conditions consist of the following:

  • Born between 1945 and 1965
  • Had a blood transfusion before the year 1992
  • Considered at high risk of having hepatitis C virus. You are considered at high risk of having hepatitis C virus if you have a current or past history of using certain injectable drugs. 

For people at high risks of having hepatitis C virus, Medicare Part B provides coverage for one hepatitis C test a year. Most of the time, Medicare Part B covers 100 percent of the costs of medically necessary laboratory tests, including hepatitis C screenings.

Part C and Part D Coverage for Hepatitis C Screening

Medicare Advantage plans (Medicare Part C) also provide coverage for hepatitis C screenings. They have to cover everything Original Medicare covers but will offer some additional benefits too. However, exactly what it covers and how much the out-of-pocket costs are will vary depending on the specifics of your plan. 

Medicare also provides coverage for hepatitis C treatment. This coverage is often provided by Medicare Part C and Medicare Part D. That is because treatment for hepatitis C often involves medications. 

Medicare Part D plans provide coverage for medications that you need for treatment of hepatitis C. Part D is a prescription drug plan, and just like Medicare Part C, Medicare Part D plans are provided by private insurance companies.

How Much Does A Hepatitis C Screening Cost?

A hepatitis C blood test may cost around $100. This cost can vary a bit though depending on the provider.

Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage and Medigap plans. Always be sure to double check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.

Additional Info on Medicare Coverage

This article is part of our series on “What does Medicare cover?”

Also, you can check out other articles in this series including: Does Medicare cover antivenom?

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