Viral Hepatitis Preventive Services Coverage

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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

Hepatitis A: Vaccination table
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 Travelexternal icon 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

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):
  • all infants, children ≤ 19
  • all unvaccinated adults at risk^ for HBV infection
  • all adults requesting protection from HBV infection, and
  • pregnant women who are identified as being at risk for HBV infection during pregnancy. 4,5

(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

Hepatitis B: Testing table
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: Screeningexternal icon for additional information.)

Non-grandfathered private health insurance plans

Medicareexternal icon

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, 2014external icon for additional information.)

Non-grandfathered private health insurance plans

Medicareexternal icon

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

Hepatitis C: Testing table
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: Screeningexternal icon 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.


 

Provisions and application to plan types
Non-grandfathered private health insurance plans

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-grandfatheredexternal icon 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:

  1. Evidence-based items or services that have an “A” or “B” recommendation rating from the United States Preventive Services Task Force (USPSTF).
  2. Immunizations recommended for routine use in children, adolescents, and adults by the Advisory Committee on Immunization Practices (ACIP).
  3. 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.
  4. 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.
Medicare
Under the ACA, USPSTF services with a Grade “A” or “B” must be covered without cost sharing if the Secretary determines they are a) reasonable and necessary for the prevention or early detection of an illness or disability, and b) appropriate for individuals entitled to benefits under part A or enrolled under part B preventive care recommendations.10
Medicaid expansion plans
Medicaid expansion plans offered by states that extend Medicaid eligibility to non-elderly individuals with annual incomes at or below 133 percent of the federal poverty level ($16,611 for an individual or $34,247 for a family of 4 in 2019) are required to cover the full range of preventive services required in the essential health benefits (EHB) final rule.  This encompasses coverage without cost sharing for all services outlined in Section 2713 of the PHS Act (see above under “Non-grandfathered private health insurance plans)11,12
Traditional Medicaid plans
Section 4106 provides that states who elect to cover all USPSTF Grade “A” or “B” recommended preventive services, as well as ACIP recommended vaccines and their administration, without cost-sharing shall receive a one percentage point increase in the federal medical assistance percentage (FMAP) for those services.13

In addition to these services, private and public plans may cover other preventive services without cost-sharing.

References
  1. Prevention of Hepatitis A Through Active or Passive Immunization. Centers for Disease Control and Prevention. MMWR 2006; 55(RR07);1-23.
  2. 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.
  3. Recommendations of the Advisory Committee on Immunization Practices for Use of Hepatitis A Vaccine for Postexposure Prophylaxis and for Preexposure Prophylaxis for International Travelexternal icon. Centers for Disease Control and Prevention. MMWR 2018; 67:1216–1220.
  4. 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.
  5. 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
  6. Hepatitis B Virus Infection in Pregnant Women: Screeningexternal icon; U.S. Preventive Services Task Force. July 2019
  7. Hepatitis B Virus Infection: Screening, 2014external icon; U.S. Preventive Services Task Force. June 2014
  8. Hepatitis C Virus Infection in Adolescents and Adults: Screeningexternal icon; U.S. Preventive Services Task Force. March 2020
  9. Coverage of Certain Preventive Services Under the Affordable Care Actexternal icon; U.S. Department of Health & Human Services. July 2015
  10. U.S.C. § 1395lexternal icon (see U.S.C. § 1395x(ddd)external icon for definitions of preventive services)
  11. Annual Update of the HHS Poverty Guidelinespdf iconexternal icon. 84 FR 1167; 1167-1168. February 2019.
  12. 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.  pdf iconexternal icon78 FR 42159; 42224-42226. July 2013
  13. State Medicaid Director letter #13-002, regarding “Affordable Care Act Section 4106”pdf iconexternal icon. 2013. Centers for Medicare & Medicaid Services (CMS).

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Page last reviewed: May 5, 2020