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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. Medicare – All USPSTF recommended services that have a Grade “A” or “B” and that are covered by Medicare must be covered without cost-sharing.2
  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 ($15,880 for an individual or $32,319 for a family of 4 in 2016) are required to cover services without cost-sharing.3,4
  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.5

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

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)
(Recommendations issued and adopted by the Director of the Centers for Disease Control and Prevention May 2006).

Routine hepatitis A vaccination for children, for persons who are at increased risk for infection, and for any person wishing to obtain immunity.6

(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 as above.

Hepatitis B Vaccination

Advisory Committee on Immunization Practices (ACIP)
(Recommendations issued and adopted by the Director of the Centers for Disease Control and Prevention December 2005)

Universal vaccination for infants; vaccination of children and adolescents who were not previously vaccinated, pregnant women who are identified as being at risk for hepatitis B virus (HBV) infection during pregnancy, unvaccinated adults at risk for HBV infection, and all adults requesting protection from HBV infection.7,8

(See MMWR: A Comprehensive Immunization Strategy to Eliminate Transmission of Hepatitis B Virus Infection in the United States Part 1: Immunization of Infants, Children, and Adolescents and MMWR: A Comprehensive Immunization Strategy to Eliminate Transmission of Hepatitis B Virus Infection in the United States Part 2: Immunization of Adults 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.10
  • Medicaid expansion plans
  • Traditional Medicaid plans
    Optional as above.

Hepatitis B Testing

 USPSTF
(Grade “A” recommendation issued June 2009)

Screening for hepatitis B virus infection in pregnant women at their first prenatal visit.9

(See USPSTF Clinical Considerations for Screening for Hepatitis B Virus Infection in Pregnancy 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.10
  • Medicaid expansion plans
  • Traditional Medicaid plans
    Optional as above.

Hepatitis B Testing

 USPSTF
(Grade “B” recommendation issued May 2014)

Screening for hepatitis B virus (HBV) infection in persons at high risk for infection.13

(See USPSTF Clinical Considerations for Screening for Hepatitis B Virus Infection for additional information.)
  • Non-grandfathered private health insurance plans
  • Medicaid expansion plans
  • Traditional Medicaid plans
    Optional as above.

Hepatitis C Testing

USPSTF
(Grade “B” recommendation issued June 25, 2013)

Screening for hepatitis C virus infection in persons at high risk for infection; offering 1-time screening for HCV infection to adults born between 1945 and 1965.11

(See USPSTF Clinical Considerations for Screening for Hepatitis C Virus Infection in Adults for additional information.)
  • Non-grandfathered private health insurance plans
    Coverage went into effect for plan years beginning after June 25, 2014.1
  • Medicare
    A screening test is covered for adults at high risk for HCV infection. Repeat screening for high risk persons is covered annually only for persons who have had continued illicit injection drug use since the prior negative screening test.
    A single screening test is covered for adults who do not meet the high risk definition above, but who were born from 1945 through 1965.12
  • Medicaid expansion plans
  • Traditional Medicaid plans
    Optional as above.

NOTE: Programs in states that are implementing “alternative” means to expand Medicaid (i.e. expanding Medicaid through “premium assistance”) should be mindful of state decisions regarding coverage and cost-sharing of these preventive services for newly eligible Medicaid enrollees.

References

1 Preventive Services Covered Under the ACA. U.S. Department of Health & Human Services.

2 Patient Protection and Affordable Care Act, Pub. L. No. 111-148, §4104, 124 Stat. 125, 557-558 (2010)

3 Patient Protection and Affordable Care Act, Pub. L. No. 111-148, §2001, 124 Stat. 121, 271-272 (2010)

4 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. 78 FR 42159; 42224-42226

5 Patient Protection and Affordable Care Act, Pub. L. No. 111-148, §4106, 124 Stat. 125, 559-560 (2010)

6 Prevention of Hepatitis A Through Active or Passive Immunization. Centers for Disease Control and Prevention. MMWR 2006; 55(RR07);1-23.

7 A Comprehensive Immunization Strategy to Eliminate Transmission of Hepatitis B Virus Infection in the United States Part 1: Immunization of Infants, Children, and Adolescents. Centers for Disease Control and Prevention. MMWR 2005; 54(RR16);1-23.

8 A Comprehensive Immunization Strategy to Eliminate Transmission of Hepatitis B Virus Infection in the United States Part 2: Immunization of Adults. Centers for Disease Control and Prevention. MMWR 2006; 55(RR16);1-25.

9 Screening for Hepatitis B Virus Infection in Pregnancy: U.S. Preventive Services Task Force Reaffirmation Recommendation Statement. U.S. Preventive Services Task Force. Issued June 2009. AHRQ Publication No. 09-05134-EF-1.

10 Pub 100-03 Medicare National Coverage Determinations. Centers for Medicare and Medicaid Services. Chapter 1, Section 210.10.

11 Screening for Hepatitis C Virus Infection in Adults: U.S. Preventive Services Task Force Recommendation Statement. U.S. Preventive Services Task Force. Issued June 2013. AHRQ Publication No. 12-05174-EF-2.

12 Decision Memorandum for Screening for Hepatitis C Virus (HCV) in Adults. Centers for Medicare and Medicaid Services.

13 Final Recommendation Statement: Hepatitis B Virus Infection: Screening, 2014. U.S. Preventive Services Task Force.

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