Viral Hepatitis Preventive Services Coverage
The Affordable Care Act (ACA) includes several provisions aimed at improving coverage of, and access to, certain preventive health services. These services and the health insurance plans that cover them without cost-sharing are summarized here in these Preventive Services Coverage Tables. Additional details around select ACA provisions and their application to specific health plan types are included below the tables.
Hepatitis A: Vaccination
| Recommending Authority | Eligible Populations and Service Specifics | Plans That Cover Without Cost-Sharing |
|---|---|---|
| ACIP (May 2006 and February 2019) |
Routine vaccination is recommended for the following groups for hepatitis A (HAV) immunization: children, persons who are at increased risk for infection, all persons experiencing homelessness, and any person wishing to obtain immunity.1,2 (See MMWR: Prevention of Hepatitis A Through Active or Passive Immunization: Recommendations of the Advisory Committee on Immunization Practices (ACIP) and MMWR: Recommendations of the Advisory Committee on Immunization Practices for Use of Hepatitis A Vaccine for Persons Experiencing Homelessness for additional information.) |
Non-grandfathered private health insurance plans Medicaid expansion plans Traditional Medicaid plans* |
| ACIP (November 2018) |
Hepatitis A vaccine for postexposure prophylaxis is recommended to all persons aged ≥12 months. Hepatitis A vaccine for preexposure prophylaxis is recommended for unvaccinated persons traveling to or working in countries that have high or intermediate HAV endemicity.3 (See MMWR: Recommendations of the Advisory Committee on Immunization Practices for Use of Hepatitis A Vaccine for Postexposure Prophylaxis and for Preexposure Prophylaxis for International Travel for additional information.) |
Non-grandfathered private health insurance plans Medicaid expansion plans Traditional Medicaid plans* |
*Optional for adults, depending on state policy; however, preventive services for children are often covered as part of the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit for children.
Hepatitis B: Vaccination
| Recommending Authority | Eligible Populations and Service Specifics | Plans That Cover Without Cost-Sharing |
|---|---|---|
| ACIP (January 2018) |
Vaccinate the following populations for hepatitis B (HBV):
(See MMWR: Prevention of Hepatitis B Virus Infection in the United States: Recommendations of the Advisory Committee on Immunization Practices and MMWR: Recommendations of the Advisory Committee on Immunization Practices for Use of a Hepatitis B Vaccine with a Novel Adjuvant for additional information.) |
Non-grandfathered private health insurance plans Medicaid expansion plans Traditional Medicaid plans* |
^See MMWR Box 4 for specific information on persons at risk for hepatitis B.
*Optional for adults, depending on state policy; however, preventive services for children are often covered as part of the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit for children.
Hepatitis B: Testing
| Recommending Authority | Eligible Populations and Service Specifics | Plans That Cover Without Cost-Sharing |
|---|---|---|
| USPSTF (Grade “A”; July 2019) |
Screen pregnant women for hepatitis B virus infection at their first prenatal visit.6 (See Hepatitis B Virus Infection in Pregnant Women: Screening for additional information.) |
Non-grandfathered private health insurance plans Medicaid expansion plans Traditional Medicaid plans* |
| USPSTF (Grade “B”; May 2014) |
Screen persons at high risk for hepatitis B virus (HBV) infection.7 (See Hepatitis B Virus Infection: Screening, 2014 for additional information.) |
Non-grandfathered private health insurance plans Medicaid expansion plans Traditional Medicaid plans* |
*Optional for adults, depending on state policy; however, preventive services for children are often covered as part of the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit for children.
Hepatitis C: Testing
| Recommending Authority | Eligible Populations and Service Specifics | Plans That Cover Without Cost-Sharing |
|---|---|---|
| USPSTF (Grade “B”; March 2020) |
Screen for hepatitis C virus infection in adults ages 18 to 79 years.8 (See Hepatitis C Virus Infection in Adolescents and Adults: Screening for additional information.) |
Non-grandfathered private health insurance plans Medicare Medicaid expansion plans Traditional Medicaid plans* |
*Optional for adults, depending on state policy; however, preventive services for children are often covered as part of the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit for children.
Section 2713 of the Public Health Service (PHS) Act, as added by the Affordable Care Act and incorporated into ERISA (The Employee Retirement Income Security Act of 1974) and the Code, requires that non-grandfathered group health plans and health insurance issuers offering non-grandfathered group or individual health insurance coverage provide coverage of certain specified preventive services without cost sharing.9 These preventive services include:
- Evidence-based items or services that have an “A” or “B” recommendation rating from the United States Preventive Services Task Force (USPSTF).
- Immunizations recommended for routine use in children, adolescents, and adults by the Advisory Committee on Immunization Practices (ACIP).
- Evidence-informed recommendations to improve the health and wellbeing of infants, children, and adolescents that are included in the Health Resources and Services Administration’s (HRSA’s) Bright Futures Project.
- Recommended services included in the HRSA-supported Women’s Preventive Services Guidelines, including all Food and Drug Administration (FDA)-approved contraceptives, sterilization procedures, and patient education and counseling for women with reproductive capacity, as prescribed by a health care provider.
In addition to these services, private and public plans may cover other preventive services without cost-sharing.
- Prevention of Hepatitis A Through Active or Passive Immunization. Centers for Disease Control and Prevention. MMWR 2006; 55(RR07);1-23.
- Recommendations of the Advisory Committee on Immunization Practices for Use of Hepatitis A Vaccine for Persons Experiencing Homelessness. Centers for Disease Control and Prevention. MMWR 2019; 68:153–156.
- Recommendations of the Advisory Committee on Immunization Practices for Use of Hepatitis A Vaccine for Postexposure Prophylaxis and for Preexposure Prophylaxis for International Travel. Centers for Disease Control and Prevention. MMWR 2018; 67:1216–1220.
- Prevention of Hepatitis B Virus Infection in the United States: Recommendations of the Advisory Committee on Immunization Practices. Centers for Disease Control and Prevention. MMWR 2018 (RR-1): 1–31.
- Recommendations of the Advisory Committee on Immunization Practices for Use of a Hepatitis B Vaccine with a Novel Adjuvant. Centers for Disease Control and Prevention. MMWR 2018; 67:455–458
- Hepatitis B Virus Infection in Pregnant Women: Screening; U.S. Preventive Services Task Force. July 2019
- Hepatitis B Virus Infection: Screening, 2014; U.S. Preventive Services Task Force. June 2014
- Hepatitis C Virus Infection in Adolescents and Adults: Screening; U.S. Preventive Services Task Force. March 2020
- Coverage of Certain Preventive Services Under the Affordable Care Act; U.S. Department of Health & Human Services. July 2015
- U.S.C. § 1395l (see U.S.C. § 1395x(ddd) for definitions of preventive services)
- Annual Update of the HHS Poverty Guidelines. 84 FR 1167; 1167-1168. February 2019.
- Medicaid and Children’s Health Insurance Programs: Essential Health Benefits in Alternative Benefit Plans, Eligibility Notices, Fair Hearing and Appeal Processes, and Premiums and Cost Sharing; Exchanges: Eligibility and Enrollment; Final Rule. 78 FR 42159; 42224-42226. July 2013
- State Medicaid Director letter #13-002, regarding “Affordable Care Act Section 4106”. 2013. Centers for Medicare & Medicaid Services (CMS).
