Does Medicare pay for hepatitis C treatment is one of the most common questions among older adults and people with disabilities in the United States. As of today, Medicare does cover hepatitis C treatment, including the antiviral medications that can cure the infection. Coverage depends on the type of Medicare plan you have and how your prescription drug benefits are structured.
This article explains exactly how Medicare pays for hepatitis C treatment, what is covered, what costs you may face, and what beneficiaries need to know right now.
How Medicare Covers Hepatitis C Treatment
Medicare coverage for hepatitis C treatment is real and active nationwide. The coverage is divided across different parts of Medicare, each handling a specific aspect of care.
Medicare Part D: Prescription Drug Coverage
Medicare Part D is the primary way Medicare pays for hepatitis C treatment medications.
Most Part D plans cover FDA-approved direct-acting antiviral drugs. These medications are the standard treatment for hepatitis C and are proven to cure the infection in most patients after a short treatment course.
Key points about Part D coverage include:
- Every Medicare Part D plan must include at least one hepatitis C treatment option on its formulary
- Coverage varies by plan, including which drugs are preferred
- Prior authorization is common before treatment is approved
- Cost-sharing depends on the plan’s drug tier system
If you are enrolled in Original Medicare, you must have a separate Part D plan to receive drug coverage.
Medicare Advantage Plans (Part C)
Medicare Advantage plans that include prescription drug coverage also pay for hepatitis C treatment.
These plans are required to provide coverage that is at least equal to what Original Medicare and Part D offer. Many beneficiaries receive hepatitis C medications through Medicare Advantage plans, with costs and rules varying by insurer.
Medicare Advantage plans may:
- Use different copayment or coinsurance amounts
- Require prior authorization
- Place drugs on specific formulary tiers
Checking your plan’s drug list is essential before starting treatment.
Medicare Part B: Medical Services and Testing
Medicare Part B does not usually pay for hepatitis C medications, but it covers important related services, including:
- Doctor visits related to hepatitis C care
- Blood tests and liver function tests
- Hepatitis C screening for eligible beneficiaries
Hepatitis C screening is covered at no cost for people who meet Medicare’s eligibility rules, including those at increased risk.
Medicare Part A: Hospital Care
Medicare Part A covers inpatient hospital services if hepatitis C complications require hospitalization. This can include treatment for severe liver disease, infections, or other serious conditions related to hepatitis C.
Which Hepatitis C Medications Are Covered
Medicare drug plans cover modern hepatitis C treatments known as direct-acting antivirals. These medications are taken orally and usually last 8 to 12 weeks.
Commonly covered medications include:
- Epclusa
- Harvoni
- Mavyret
- Zepatier
Not every plan covers every drug, but all plans must provide access to treatment. Your doctor may need to submit medical documentation to confirm medical necessity.
Prior Authorization and Treatment Approval
Most Medicare drug plans require prior authorization for hepatitis C treatment.
This process usually involves:
- Confirmation of hepatitis C diagnosis
- Lab results showing viral load and genotype
- Treatment history, if any
- Medical necessity documentation
While this step can delay treatment briefly, approval is common when documentation is complete.
How Much Does Hepatitis C Treatment Cost With Medicare
Even when Medicare pays for hepatitis C treatment, beneficiaries usually have some out-of-pocket costs.
These costs may include:
- Monthly Part D or Medicare Advantage premiums
- Annual deductibles
- Copayments or coinsurance for medications
In 2025, Medicare Part D includes an annual out-of-pocket cap of $2,000 for covered prescription drugs. Once you reach that amount, you pay nothing more for covered medications for the rest of the year.
This cap significantly reduces the financial burden for people receiving hepatitis C treatment.
Help Paying for Hepatitis C Treatment Costs
If costs are still difficult to manage, several assistance options may be available.
These include:
- Medicare Extra Help for people with limited income
- State pharmaceutical assistance programs
- Patient assistance programs for eligible individuals
Eligibility depends on income, assets, and enrollment status.
Hepatitis C Screening Coverage Under Medicare
Medicare also pays for hepatitis C screening tests, which are essential for early diagnosis.
Screening is covered under Part B for:
- People at high risk
- Individuals with past exposure
- Certain age groups based on medical guidelines
When performed by a Medicare-participating provider, eligible screenings are covered without cost-sharing.
What Medicare Beneficiaries Should Do Next
To ensure smooth access to treatment:
- Review your Medicare drug plan’s formulary
- Ask your doctor about prior authorization requirements
- Confirm expected out-of-pocket costs before starting treatment
- Compare plans during enrollment periods if coverage is limited
Early planning helps avoid delays and unexpected expenses.
Final Answer: Does Medicare Pay for Hepatitis C Treatment?
Yes, Medicare does pay for hepatitis C treatment. Prescription drug coverage under Part D or Medicare Advantage plans covers antiviral medications, while Parts A and B cover related medical services. Coverage details and costs vary by plan, but treatment access is widely available across the U.S.
Have questions or personal experiences with Medicare and hepatitis C treatment? Share your thoughts or stay connected for future updates.