Viral Hepatitis Preventive Services

The Affordable Care Act requires coverage of recommended preventive services without cost-sharing for the following health plans:

  1. Non-grandfathered private health insurance plans – Most private insurance plans, including all plans on the Health Insurance Marketplace, and all group or individual health insurance plans that did not exist on March 23, 2010—or that have made significant changes to benefits, cost-sharing, or limits since that time—are required to cover services without cost-sharing.1,2
  2. Medicare – All USPSTF recommended services that have a Grade “A” or “B” and that are covered by Medicare must be covered without cost-sharing.3
  3. Medicaid expansion plans in states that expanded (i.e. Alternative Benefit 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 ($16,040 for an individual or $32,718 for a family of 4 in 2017) are required to cover services without cost-sharing.4,5
  4. Traditional Medicaid plans – Those states that, at their option, cover without cost-sharing in their standard Medicaid benefit package all USPSTF-recommended services that have a Grade “A” or “B” and all ACIP-recommended vaccines receive an increase in their federal medical assistance for such services and vaccines.6

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

Preventive services for viral hepatitis that may be covered without cost-sharing, pursuant to Affordable Care Act (ACA) requirements.
Preventive Service Recommending Authority
(authorized under Section 1001 of the Patient Protection and Affordable Care Act)
Eligible Populations and Service Specifics Health Insurance Plans That Cover the Service Without Cost-Sharing
Hepatitis A Vaccination Advisory Committee on Immunization Practices (ACIP)
(May 2006)
Routinely vaccinate the following groups for hepatitis A vaccination: children, for persons who are at increased risk for infection, and for any person wishing to obtain immunity.7

(See MMWR: Prevention of Hepatitis A Through Active or Passive Immunization: Recommendations of the Advisory Committee on Immunization Practices (ACIP) for additional information.)

  • Non-grandfathered private health insurance plans
  • Medicaid expansion plans
  • Traditional Medicaid plans Optional.
Hepatitis B Vaccination Advisory Committee on Immunization Practices (ACIP)
(January 2018)
Vaccinate the following populations for Hepatitis B:
  • 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.8

(See MMWR: Prevention of Hepatitis B Virus Infection in the United States: Recommendations of the Advisory Committee on Immunization Practices for additional information.)

  • Non-grandfathered private health insurance plans
  • Medicare
  • Medicaid expansion plans
  • Traditional Medicaid plans Optional as above.
Hepatitis B Testing Advisory Committee on Immunization Practices (ACIP)
(January 2018)
Screen the following groups for HBV infection:
  • persons at increased risk for infection; and
  • all pregnant women, who should be tested for HBsAg during an early prenatal visit (e.g., first trimester) in each pregnancy, even if they have been vaccinated or tested previously8

(See MMWR: Prevention of Hepatitis B Virus Infection in the United States: Recommendations of the Advisory Committee on Immunization Practices for additional information)

  • Non-grandfathered private health insurance plans
  • Medicare
    • Medicare covers hepatitis B testing for pregnant women at the first prenatal visit when the diagnosis of pregnancy is known, and then re-screening at the time of delivery for those with new or continuing risk factors.9
    • Medicare covers screening for asymptomatic, nonpregnant adolescents and adults at high risk for HBV infection. Repeated screening on an annual basis is covered for beneficiaries with continued high risk.9
  • Medicaid expansion plans
  • Traditional Medicaid plans Optional as above.
USPSTF
(Grade “A” recommendation issued June 2009)
Screen pregnant women for hepatitis B virus infection at their first prenatal visit.10
(See USPSTF Final Recommendation Statement: Hepatitis B in Pregnant Women: ScreeningExternal for additional information.)
  • Non-grandfathered private health insurance plans
  • Medicare Medicare covers hepatitis B testing for pregnant women at the first prenatal visit when the diagnosis of pregnancy is known, and then re-screening at the time of delivery for those with new or continuing risk factors.9
  • Medicaid expansion plans
  • Traditional Medicaid plans Optional as above.
USPSTF
(Grade “B” recommendation issued May 2014)
Screen persons at high risk for hepatitis B virus (HBV) infection.11
(See USPSTF Final Recommendation Statement: Hepatitis B Virus Infection: Screening, 2014External for additional information.)
  • Non-grandfathered private health insurance plans
  • Medicare Medicare covers screening for asymptomatic, nonpregnant adolescents and adults at high risk for HBV infection. Repeated screening on an annual basis is covered for beneficiaries with continued high risk.9
  • Medicaid expansion plans
  • Traditional Medicaid plans Optional as above.
Hepatitis C Testing USPSTF
(Grade “B” recommendation issued June 2013)
Screen the following groups for hepatitis C virus infection:
  • persons at high risk for infection, and
  • adults born between 1945 and 1965 (one time screening).12

(See USPSTF Final Recommendation Statement: Hepatitis C: ScreeningExternal for additional information.)

  • Non-grandfathered private health insurance plans.
  • Medicare Medicare covers HCV screening for:
    • persons at risk high (a current or past history of illicit injection drug use;
    • persons who have a history of receiving a blood transfusion prior to 1992, and)
    • adults born from 1945 through 1965.13
  • Medicaid expansion plans
  • Traditional Medicaid plans Optional as above.
References
  1. 42 U.S.C. § 300gg–13External
  2. Coverage of Certain Preventive Services Under the Affordable Care ActExternal; U.S. Department of Health & Human Services
  3. 42 U.S.C. § 1395lExternal
  4. 42 U.S.C. § 1396aExternal
  5. 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.Cdc-pdfExternal 78 FR 42159; 42224-42226. July 2013
  6. 43 U.S.C. § 1396dExternal
  7. Prevention of Hepatitis A Through Active or Passive Immunization. Centers for Disease Control and Prevention. MMWR 2006; 55(RR07);1-23.
  8. 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.
  9. National Coverage Determination (NCD) Screening for Hepatitis B Virus (HBV) Infection (210.6)External. Centers for Medicare and Medicaid Services September 2016.
  10. Final Recommendation Statement:  Hepatitis B in Pregnant Women: ScreeningExternal. U.S. Preventive Services Task Force. June 2009.
  11. Final Recommendation Statement: Hepatitis B Virus Infection: Screening, 2014External. U.S. Preventive Services Task Force. May 2014.
  12. Final Recommendation Statement: Hepatitis C: ScreeningExternal. U.S. Preventive Services Task Force. June 2013.
  13. National Coverage Determination (NCD) for Screening for Hepatitis C Virus (HCV) in Adults (210.13)External. Centers for Medicare and Medicaid Services. June 2014.

Page last reviewed: May 2, 2018