Medicare Covers Hepatitis C Testing For High Risk Populations

middle age couple

The only way to know if you are infected with hepatitis C is to get tested and now testing is even easier for aging “baby boomers”. Medicare will cover hepatitis C virus (HCV) testing for adults born between 1945 and 1965, as well as other high risk adults, according to a statement released by the Centers for Medicare and Medicaid Services (CMS) on June 2.

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Seventy-five percent of adults with hepatitis C were born between 1945 and 1946 and the new testing coverage will include a single screening for adults born between these years. It is estimated that one-time testing of everyone born during these years  will prevent more than 120,000 deaths.

Testing Guidelines

The CMS statement outlines that:

  • The screening must be ordered by a patient’s primary care provider “within the context of a primary care setting”.
  • The physician or practitioner requesting the screening must be an eligible Medicare provider.


In addition to covering adults born between 1945 and 1965, the screening is also available to Medicare enrollees who fit the following risk profiles:

  • Any person who has ever used “illicit injection drugs”
  • Any person who received a blood transfusion before 1992
  • Disabled adults with Medicare under the age of 65

The CMS statement also adds that current users of illicit injection drugs who are found to be HCV negative will be covered for annual repeat screenings.

Importance of Early Diagnosis

Hepatitis C is the most common type of viral hepatitis in the U.S. and more than 15,000 Americans die each year from hepatitis C-related illness. Many people with hepatitis C don’t display any concerning symptoms and often live for decades without feeling sick.

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Risk factors for hepatitis infection include:

  • History of blood transfusions or other blood products (before July 1992)
  • Organ transplant before widespread testing for HIV and hepatitis (before July 1992)
  • Long-term dialysis treatment
  • Exposure to hepatitis C such as through a healthcare setting (healthcare needle sticks)
  • Infection with HIV, the AIDS virus
  • Children born to mothers who have hepatitis C
  • Any past use of injected illegal drugs
  • Having received a tattoo with needles that were not properly disinfected

Aging baby boomers have an increased risk of developing life-threatening liver damage from hepatitis C, including liver failure, liver cancer and cirrhosis.

There are no vaccines to prevent hepatitis C, but a simple blood test can catch the illness early and get patients the treatment needed to help prevent life-altering liver damage.

For more on Medicare coverage and hepatitis C testing, consult with your doctor.

Visit the Hepatitis C center for more articles.