Is the Hepatitis B Vaccine Covered by Medicare Insurance?
As you get older, you may be tempted to neglect preventive care, especially if you’re healthy overall. Vaccines are often included in preventive care plans created by you and your physician during your annual Medicare Wellness Visit.
You may be eligible to get certain vaccines covered by Medicare Part B (medical insurance) or Part D (prescription drug coverage). Depending on your risk factors, health, and lifestyle, you may be eligible to get the hepatitis B vaccine at no cost.
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Who Needs Hepatitis Vaccinations?
How often you need a Hep B vaccine deeps on different factors. The Centers for Disease Control and Prevention recommends hepatitis vaccinations:
- All unvaccinated infants, children and adolescents under 19 years
- Adults aged 19 through 59 who weren’t previously vaccinated
- Adults over 60 with an increased risk of hepatitis B infection
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How Does Medicare Cover the Hepatitis B Vaccine?
Medicare Part B benefits include the hep B vaccine as a preventive service if you meet specific criteria. To be eligible for the vaccine, you need to have a specific condition or exposure that puts you at medium-to-high risk for getting the infection. You may qualify if you:
- Have end-stage renal disease (ESRD), hemophilia or diabetes
- Share a home with a person who has hepatitis B
- Are employed as a healthcare worker, frequently in contact with bodily fluids, including blood
Only one of the above conditions needs to be met. If you qualify and get the shot from a healthcare provider who accepts assignment from Medicare, the vaccine will be paid in full. If you are enrolled in Medicare Advantage, you may have to visit providers in the plan’s network.
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What is Hepatitis?
Hepatitis is an infection that inflames the liver and is most often caused by a virus. To appreciate the potential health issues resulting from hepatitis, it helps to understand the role of the liver. The liver is your body’s largest solid organ and gland in the body.
Primary liver functions include:
- Secretion of bile to absorb dietary fats
- Detoxification of alcohol
- Storage and release of vitamins and minerals,
- Destruction of aged cells and bacteria
- Synthesis of vitamin D in its active form
Clearly, diseases that affect the liver can have life-threatening consequences.
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What are the Different Types of Hepatitis?
Hepatitis is a global concern. The World Health Organization (WHO) estimates that 354 million people globally live with hepatitis B or C, the types most responsible for chronic liver disease in the form of cirrhosis, cancer and hepatitis.
The five primary strains of the virus that lead to hepatitis are labeled as types A, B, C, D and E. These strains are identified by the differences in their transmission, severity, geography and prevention.
Five types of hepatitis:
- Hepatitis A is mainly associated with unwashed food and contaminated water. Hep A is usually mild and often completely ressolves with treatment. In the United States, the hep A vaccine is recommended for children 12 to 23 months old and for high-risk adults.
- Hepatitis B can be transmitted through contact with infected blood but is typically contracted via bodily fluids and can be passed from mother to child during childbirth. While there is no cure for hepatitis B the hep B vaccine is a useful preventative measure.
- Hepatitis C is transmitted via exposure to infected bllod such as sharing needles or during childbirth. Prior to 1992, when healthcare professionals began regularly screening blood for hepatitis, people receiving organ transplants or blood tranfusions were at increased risk of contracting hep C. While there is no vaccine for this this disease, antiviral medications have a 90% success rate of curing hep C.
- Hepatitis D only occurs in patients also infected with hep B. Although there is currently no vaccine for hep D, getting the hep B vaccine as a preventative measure can help ensure you don’t get hep D at a later time.
- Hepatitis E is similar to hep A and mainly found in South America, Asia and Africa. There is no vaccine for hep E currently available in the U.S. but most people fully recover without complications.
The Centers for Disease Control and Prevention (CDC) reports that Hepatitis A, B and C are the most common strains in the United States. The best way to prevent hepatitis A and B is through vaccination. Chronic hep B, hep C and hep D infection can lead to long-term liver damage, cirrhosis of the liver, or liver cancer.
Tips for Protecting Yourself Against Hepatitis
The hepatitis A virus (HAV) spreads through ingestion of the virus through sexual contact, caregiving, sharing drugs and consuming contaminated food or water. The virus can contaminate food at any time between when it is grown and cooked.
HAV is more common in environments with unsanitary conditions, poor sewage systems and no potable water. To reduce your risk, be vigilant about hand hygiene by washing your hands thoroughly before you leave the bathroom, after you change diapers, and any time you touch food.
The hepatitis B virus (HBV) spreads through blood, semen, saliva and vaginal fluids. To lower your risk of contracting hep B, refrain from unprotected sex. If you inject drugs, do not share needles. If you are getting your body pierced or tattooed, go to a reputable establishment that uses sterile needles. Remember to get vaccinated before traveling to destinations where hepatitis B is common.
Difference Between Hep A and Hep B Vaccines
In the United States, the hep A shot is administered routinely to very young children. It may be given in one or two doses. If the child is getting two doses, the first one should be no later than 12 months of age. There is some flexibility in the interval between shots, but six to 18 months is common.
The hep B vaccine should be given to all babies as soon as possible after birth. After the first dose, two or three doses follow with an interval of at least four weeks. Unvaccinated adults get three doses spanning six months. If you are at least 18 years old, you have the option to get a combination vaccine. The dual vaccine is given in three shots over six months.
Adults traveling to areas with a high rate of HAV would benefit from getting the hep A shot. Talk to your physician about your risk for hep A and hep B to determine if you should receive the vaccines. You can schedule your hepatitis vaccine with your primary care physician or one of your local pharmacies, such as CVS and Walgreens.
Does Medicare Cover the Hepatitis A Vaccine?
Check your prescription drug plan, Part D, for the hepatitis A vaccine. Your Part D plan may also cover a dual vaccine that is designed to prevent both HAV and HBV diseases. TWINRIX is the brand name for the only combination vaccine on the market.
Part D plans are sold by private insurance companies, and the formularies reflecting approved drugs will vary across plans and insurers. If you don’t see TWINRIX in your formulary, contact your plan administrator to find out if the vaccine is covered.
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Other immunizations covered under Part D include the shingles vaccine (SHINGRIX), and the Tetanus, diphtheria and pertussis shot. Medicare Part B covers shots to prevent influenza, pneumococcal and COVID-19, as well as hepatitis B.
When you search for Part D Prescription Drug Plans or Medicare Advantage plans that include prescription drug coverage, it’s a good idea to have a list of your medications handy so you can cross-reference your prescriptions with drugs in the plan’s formulary. The Part D formulary breaks down approved drugs by tier. Tiers are a way to group drugs according to generic, brand and specialty versions and costs will vary.
TIP: Using an online plan finder that enables you to enter your drug information makes it easier to filter plans that offer the coverage you need.
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