Medicare Part D covers hepatitis C treatments. However, people with hepatitis C who seek treatment with direct-acting antivirals may still be responsible for significant costs, as these are expensive medications.
Medicare typically provides insurance for people ages 65 years and older. Part D covers prescription medications, which can include drugs for hepatitis C.
Read on to learn more about Medicare coverage for hepatitis C treatments.
Glossary of Medicare terms
We may use a few terms in this article that can be helpful to understand when selecting the best insurance plan:
- Out-of-pocket costs: An out-of-pocket cost is the amount a person must pay for medical care when Medicare does not pay the total cost or offer coverage. These costs can include deductibles, coinsurance, copayments, and premiums.
- Deductible: This is an annual amount a person must spend out of pocket within a certain period before an insurer starts to fund their treatments.
- Coinsurance: This is the percentage of treatment costs that a person must self-fund. For Medicare Part B, this is 20%.
- Copayment: This is a fixed dollar amount a person with insurance pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
As treatment for hepatitis C is
Medicare Part D is available either alongside Original Medicare, which comprises parts A and B, or as part of a private Medicare Advantage plan that provides drug coverage in line with Medicare rules.
Medicare Part A may cover any in-hospital treatment for hepatitis C in full. Some people
Part B covers outpatient treatment, doctor visits, and testing. For hepatitis C, these would include consultations relating to the condition alongside screenings, in some cases.
The specific medications Medicare covers to treat hepatitis C may vary depending on the specific formulary. The formulary is a list of drugs a specific plan covers.
New hepatitis C medications enter the market regularly. According to a
- simeprevir
- sofosbuvir
- ledipasvir or sofosbuvir
- ombitasvir, paritaprevir, or ritonavir with dasabuvir
Every plan in the study covered simeprevir and sofosbuvir.
Learn more about hepatitis C medications.
Hepatitis C drugs can be expensive. The average out-of-pocket costs in 2020 for people with Medicare was $3,130 for lower cost drugs and $5,351 for higher cost drugs, according to the Department of Health and Human Services.
For people on a low income subsidy, average out-of-pocket costs ranged from $28 to $75.
The cost of hepatitis C medications will differ based on the chosen plan, depending on:
- whether a prescription is on a particular plan’s formulary
- the formulary tier a drug is in
- the pharmacy a person uses and whether it is in the plan’s network
- whether a person receives Extra Help benefits
- whether an individual chooses generic or brand-name medications
- the phase of coverage
2024 coverage
Drug costs go through four phases of coverage with Medicare Part D, and individual responsibility for costs varies with each one.
| Coverage phase | Individual responsibility | Additional details |
| Deductible | 100% | The deductible varies by plan, but it cannot exceed $545 in 2024. Some plans have no deductible. |
| Initial coverage | 25% | In 2024, the initial coverage period ends after the plan has paid $5,030 in drug coverage. |
| Coverage gap | 25% | The plan covers 75% of the costs for generic drugs. It covers 5% for brand-name drugs, with a 70% discount from the drug manufacturer. |
| Catastrophic coverage | 0% | Catastrophic coverage begins when a person has reached $8,000 in out-of-pocket costs. It lasts until December 31. On January 1 the following year, the plan will return to the deductible coverage phase. |
2025 coverage
The Centers for Medicare & Medicaid Services (CMS) has released the Plan D coverage information for 2025. Changes to the four phases of coverage include:
- three coverage phases:
- annual deductible
- initial coverage
- catastrophic coverage
- an annual deductible of $590, up from $545 in 2024
- elimination of the coverage gap phase
- a lower out-of-pocket maximum of $2,000, down from $8,000 in 2024
Learn more about Medicare Part D costs.
According to a
Other medications can be similarly costly. A 2020 study comparing United States and Canadian hepatitis C medication prices looked at the estimated costs of a 28-day supply of certain drugs in 2019. The drug prices were as follows:
- Sofosbuvir (Sovaldi): $27,728
- Sofosbuvir/velpatasvir/voxilaprevir (Vosevi): $24,679
- Ombitasvir/paritaprevir/ritonavir (Technivie): $12,656
- Ledipasvir/sofosbuvir (Harvoni): $10,088
- Velpatasvir/sofosbuvir (Epclusa): $6,728
- Glecaprevir/pibrentasvir (Mavyret): $4,367
Generic versions of these drugs are available at a lower cost.
Medicare pays for an annual screening for people who meet the following criteria:
- those who have used or continue to use injectable illegal drugs
- those who received a blood transfusion before 1992
- individuals born between 1945 and 1965
For Medicare to fund a screening, a healthcare professional must request it. Medicare will also cover a one-off screening for those born between 1945 and 1965 who do not have a high risk of hepatitis C.
When booking with a healthcare professional who accepts assignment, people will pay nothing outside their deductible or coinsurance. An assignment is an agreement that Medicare will pay the healthcare professional directly and accept the Medicare-approved amount without billing the individual extra.
Learn about hepatitis C screenings.
The Medicare Extra Help program can help with the costs of hepatitis C treatments for people with limited income.
Other programs can also help connect people with financial support for hepatitis C treatments.
The American Liver Foundation offers a free Drug Discount Card to reduce costs. Other avenues of financial hepatitis C support include:
- the pharmaceutical companies that produce hepatitis C drugs, which sponsor prescription assistance programs
- NeedyMeds, a nonprofit supporting those who cannot afford medication
- The Partnership for Prescription Assistance
- RxOutreach, a nonprofit mail-order pharmacy
- state pharmaceutical assistance programs
Medicaid can also fund treatment with direct-acting antivirals, though
Medicare resources
For more resources to help guide you through the complex world of medical insurance, visit our Medicare hub.
Medicare Part D covers hepatitis C treatments, but the exact medications the plans cover may vary depending on the formulary.
As hepatitis C medications are generally expensive, people with Medicare Part D may still face considerable out-of-pocket costs. These vary depending on several factors, including whether the pharmacy is in-network.
Medicare Extra Help can help reduce costs for people on lower incomes, and financial support is available from nonprofits, Medicaid, and the American Liver Foundation.