Does Medicare Cover Hepatitis C Treatment?

Hepatitis C treatment is important because the condition can lead to liver cancer and liver failure. And unlike hepatitis A and hepatitis B, there is no vaccine to prevent contracting hepatitis C. 

Original Medicare and Medicare Advantage typically cover hepatitis C treatments, including direct-acting antivirals (DAAs), which can cure the condition. Here’s what else you need to know about Medicare and hepatitis C treatment.

What hepatitis C treatments does Medicare cover?

Medicare covers direct-acting antivirals (DAAs), a category of newer medications, as well as older, injectable treatments. DAAs have a 95% or higher hepatitis C cure rate. The medications are usually taken for 8 to 12 weeks, but treatment can go as long as 24 weeks. 

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In most cases, the older injectable medications are no longer considered first-choice treatment options, since they don’t cure hepatitis C and cause side effects. However, most Medicare Part D prescription medication plans cover them with a prior authorization if you meet certain guidelines.

What is hepatitis C?

Hepatitis C is a liver infection. It’s caused by the hepatitis C virus (HCV), which is passed through contact with an infected person’s blood. The virus attacks the liver, leading to inflammation. 

Often, people don’t experience any symptoms from hepatitis C for decades. But long-term inflammation related to an infection can cause liver scarring, known as cirrhosis. Hepatitis C increases the likelihood of developing liver failure and liver cancer. 

EXPERT PICKS: WHAT TO READ NEXT

• Treating hepatitis C: These are the most common hepatitis C medications, which include older injections and newer pills.

• Hepatitis C can be cured. Find out about the pros and cons of direct-acting antivirals (DAAs), which can cure hepatitis C.

• Do you need a prior authorization? Getting your hepatitis C medications covered by insurance may require preapproval from your plan.

How does Medicare cover hepatitis C treatments?

Here are the types of coverage you can expect with Medicare.

Part A

Part A covers hepatitis C treatments and medications that are received as part of inpatient hospital care. 

Part B

Part B covers hepatitis C services received as part of outpatient care, such as hepatitis C screenings, lab tests, initial consults with a primary care physician, and follow-up visits. Medicare Part B mainly covers hepatitis C treatments given as IV infusions and injections in an outpatient care setting.

Medicare Advantage (Part C)

Medicare Advantage plans must offer coverage that meets or exceeds the benefits offered by original Medicare (Part A and Part B). Most Medicare Advantage plans also include Part D prescription medication coverage.

Part D

Part D plans cover prescription medications that treat hepatitis C. But you may need to get a prior authorization before your plan will cover your medication.

You will need to see a specialist in liver diseases — such as a hepatologist, gastroenterologist, or infectious diseases physician — or an advanced practice healthcare professional, such as a nurse practitioner, to obtain a prescription for hepatitis C medication. 

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Medigap

Medigap, or Medicare supplement insurance, can be used to pay for some or all of the out-of-pocket costs associated with original Medicare. Enrolling in a plan can provide additional coverage for deductibles, copays, and coinsurance.

Medicare out-of-pocket costs

Even though Medicare covers hepatitis C treatment, you can still be responsible for deductibles, copays, and coinsurance. With Medicare Part D coverage, your out-of-pocket costs can still range from $3,000 to $5,000 or more for a 12-week course of treatment.

However, you could pay as little as $0 for hepatitis C medication if you have limited financial resources and qualify for the Part D low-income subsidy (LIS), known as Extra Help.

If Medicare denies your request for coverage, you can appeal the decision. The appeals process is different for Medicare Part A, Part B, Medicare Advantage (Part C), and Part D.

Does Medicare cover hepatitis C medications?

Yes, Medicare covers hepatitis C medications under Part D. Epclusa, Harvoni, and Mavyret are some commonly prescribed brand-name, oral hepatitis C medications for Medicare enrollees. Though, as mentioned, older IV infusions and injections that may not cure the infection are also covered. 

How much are hepatitis C oral medications without insurance?

Without Medicare, other insurance, or discounts, treating hepatitis C with oral medication can cost from $22,000 to $95,000.

Here are recent GoodRx prices for a 28-day supply of commonly prescribed, hepatitis C oral medications.

*This is not an exhaustive list of medications that treat hepatitis C. Some, such as Rebetol (ribavirin), were not included because they must be taken in combination with other medications to treat hepatitis C.

Other types of insurance

If you have commercial health insurance, your costs will vary based on your plan.

Medicaid programs, which are run by states and territories, are required to cover nearly all FDA-approved medications when they’re prescribed their medical indications. Most Medicaid programs do not require prior authorizations, which have historically been a barrier to care, for hepatitis C medications. And people covered by Medicaid — which includes “dual eligibles” who are also enrolled in Medicare — typically have low out-of-pocket costs for these and other medications.

Tricare insurance covers some hepatitis C medications, including Mavyret, Epclusa, and Harvoni. But your prescriber may need to submit a coverage review, which is like a prior authorization. The U.S. Department of Veterans Affairs (VA) also may help cover the costs of hepatitis C medications. If you have coverage through the VA, you should discuss your options with a VA healthcare representative.

Does Medicare cover hepatitis C screenings?

Yes, original Medicare fully covers hepatitis C screenings. That means that you won’t have out-of-pocket costs for a screening if you see a healthcare professional who accepts Medicare. 

Whether you are eligible for coverage for annual screenings or one lifetime screening depends on your age and medical history:

• Annual screenings: You will typically qualify for coverage if you are considered high risk due to a history of using injectable drugs or having had a blood transfusion before 1992.

• One lifetime screening: If you were born from 1945 to 1965 and are not considered high risk for hepatitis C, it’s likely you’ll be covered for a single screening. 

If you have a Medicare Advantage plan, you may have additional coverage for screenings, beyond what original Medicare provides.

What if you can’t afford hepatitis C treatment or screening?

Government-funded community health centers, crowdfunding, and state-sponsored initiatives can all make hepatitis C screenings and treatments more affordable. Here’s a closer look at some of the options:

• Community health centers: These clinics provide affordable healthcare, including prescription medications, to people in underserved communities.

• Crowdfunding: Sites such as GoFundMe allow you to create a fundraising campaign to help pay medical bills. But be aware that the proceeds from medical crowdfunding may be considered income, which can push you out of the eligibility range for programs such as Medicaid and Supplemental Security Income (SSI). Also, most campaigns fall short of fundraising goals and are not considered a substitute for health insurance. 

• State-sponsored initiatives: Programs such as Florida’s prescription medication discount card are often available to people who are 60 and older, don’t have Medicare Part D, and meet eligibility guidelines. Search online for “help paying for prescription medications” and add your state’s name to the query to find out what’s available.

Patient assistance programs

Some medication manufacturers offer discounts through patient assistance programs for eligible individuals who are uninsured or underinsured. Here’s where to find out more about savings for some of the hepatitis C oral medications mentioned above:

• Epclusa: The Epclusa copay coupon can reduce your copays for the medication to as little as $5 if you have commercial insurance. The Gilead Support Path program also provides financial assistance for people who are uninsured or underinsured.

• Generic Epclusa (sofosbuvir / velpatasvir): Asegua Therapeutics offers a generic Epclusa copay coupon for people who have commercial insurance. There’s also financial assistance available for people who are uninsured or underinsured through Gilead Support Path.

• Harvoni: Gilead Support Path offers a Harvoni copay coupon for eligible consumers with commercial insurance. The program also provides financial assistance for people who are uninsured or underinsured.

• Generic Harvoni (ledipasvir / sofosbuvir): Asegua Therapeutics offers a generic Harvoni copay coupon for people with commercial insurance. There’s also financial assistance available for people who are uninsured or underinsured through Gilead Support Path.

• Mavyret: myAbbVie Assist provides free medication, including Mavyret, to eligible consumers. Or the Mavyret savings card can drop your out-of-pocket costs to as little as $5 a month if you have commercial insurance.

• Sovaldi: Gilead Support Path offers a Sovaldi copay coupon for people with commercial insurance. The program also provides financial assistance for people who are uninsured or underinsured.

• Vosevi: Gilead Support Path offers a Vosevi copay coupon for people with commercial insurance. The program also provides financial assistance for people who are uninsured or underinsured.

• Zepatier: The Merck Patient Assistance Program offers free medication to eligible people who are uninsured and others who cannot afford Zepatier. 

What other ways can I get hepatitis C screening and treatment for free or at a low cost?

There are several other programs that can help you access free or low-cost hepatitis C care, including:

• HealthWell Foundation: The HealthWell Foundation helps underinsured people with the costs of treating chronic or life-altering diseases, such as cancer. At the time of publication, the hepatitis C fund was closed, but it may have since reopened.

• PAN Foundation: The PAN Foundation provides financial assistance to underinsured people to cover copays, health insurance premiums, and transportation costs related to treatment. At the time of publication, the hepatitis C fund was closed to new and renewing applicants, but may have since reopened.

• Hep Free NYC: If you live in New York City, you can find help paying for hepatitis C medications through the Hep Free NYC program.

• Clinical trials: You may be able to join a clinical trial to access free hepatitis C treatment and other care.

Why trust our experts?

Written by:

Lorraine Roberte

Lorraine has been writing in-depth insurance and personal finance content for 3 years. She has written hundreds of articles on these topics, with her work appearing on such sites as the Balance, the Simple Dollar, ConsumerAffairs, and I Will Teach You To Be Rich.

Edited by:

Cindy George, MPH

Cindy George is the senior personal finance editor at GoodRx. She is an endlessly curious health journalist and digital storyteller.

Reviewed by:

Patricia Pinto-Garcia, MD, MPH

Patricia Pinto-Garcia, MD, MPH, is a medical editor at GoodRx. She is a licensed, board-certified pediatrician with more than a decade of experience in academic medicine.

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