Chronic hepatitis B is a lifelong viral infection of the liver that, left unmanaged, can lead to cirrhosis, liver failure, and liver cancer. Unlike hepatitis C, hepatitis B usually cannot be cured—but it can be controlled for decades with daily antiviral pills and careful monitoring. For Medicare beneficiaries, the good news is that the screening, the vaccine, the antiviral drugs, and the cancer surveillance are all covered. This guide explains exactly how Medicare pays across each part of hepatitis B care, where the costs land, and how it differs from the hepatitis C and liver disease story.

Screening and the Hepatitis B Vaccine—Often Free

Medicare covers hepatitis B screening under Part B at no cost (no deductible, no coinsurance) for beneficiaries at increased risk or who are pregnant, when ordered by a doctor. Because the CDC now recommends that all adults be screened at least once, most beneficiaries qualify.

Medicare also covers the hepatitis B vaccine at zero cost under Part B for people at medium or high risk—including anyone with diabetes, end-stage renal disease, hemophilia, or other risk factors. This is one of the few vaccines Medicare covers under Part B rather than Part D, and for at-risk beneficiaries it is completely free. Preventing infection is far cheaper than managing it, so this is a benefit worth using.

If you already have chronic hepatitis B, the focus shifts to monitoring and antiviral treatment.

Monitoring Your Liver: Labs and Imaging Under Part B

Living well with chronic hepatitis B means regular monitoring, most of which runs through Part B:

  • Blood tests—hepatitis B viral load (HBV DNA), liver function panels, hepatitis B surface antigen and e-antigen, and alpha-fetoprotein (AFP) for cancer surveillance. Tests processed by a clinical laboratory are covered at zero coinsurance.
  • Hepatologist and gastroenterologist visits—covered at 80 percent after the $257 deductible (2026), leaving 20 percent coinsurance.
  • Imaging—abdominal ultrasound, FibroScan (transient elastography) to measure liver scarring, and CT or MRI when needed—covered under Part B at 20 percent coinsurance.

These monitoring visits are lifelong and recurring, so the 20 percent coinsurance on visits and imaging adds up year after year—one reason supplemental coverage matters even when the disease is stable.

Antiviral Drugs: Part D and the $2,000 Cap

The cornerstone of chronic hepatitis B treatment is a daily oral antiviral taken indefinitely to suppress the virus and protect the liver. These are self-administered pills covered under Part D, not Part B:

  • Tenofovir alafenamide (Vemlidy) — a modern first-line agent, still brand-only and relatively expensive
  • Tenofovir disoproxil (Viread) — available as an inexpensive generic
  • Entecavir (Baraclude) — a widely used generic first-line option

Here is the key financial point: under the 2025 Part D redesign, your total annual out-of-pocket for all covered Part D drugs is capped at $2,000, with the option to spread payments across the year through the Medicare Prescription Payment Plan. For someone on brand-name Vemlidy, that cap is the difference between a predictable bill and an open-ended one. Patients on generic entecavir or tenofovir disoproxil often pay only modest copays well under the cap.

This is the same Part B vs. Part D drug split that shapes cost across serious diagnoses—but for routine hepatitis B, treatment lands almost entirely on the capped Part D side, which is favorable. The uncapped Part B exposure appears only if the disease progresses to liver cancer (below).

When Hepatitis B Leads to Liver Cancer

Chronic hepatitis B is one of the leading causes of hepatocellular carcinoma (HCC), so Medicare covers liver cancer surveillance—typically an ultrasound and AFP blood test every six months for at-risk patients—under Part B. Catching cancer early dramatically improves outcomes and keeps treatment less expensive.

If liver cancer does develop, the cost picture changes and the uncapped exposure appears, exactly as it does in our hepatitis C and liver disease guide:

  • Infused therapy—immunotherapy combinations such as atezolizumab (Tecentriq) plus bevacizumab, or durvalumab (Imfinzi)—are Part B drugs at 20 percent coinsurance with no annual cap.
  • Oral targeted therapy—lenvatinib (Lenvima), sorafenib, cabozantinib—are Part D drugs capped at $2,000.
  • Procedures—ablation, TACE (transarterial chemoembolization), and surgery—fall under Part A or Part B depending on the inpatient/outpatient setting.

For the broader treatment picture, see our Medicare cancer treatment coverage guide. The takeaway: the routine antiviral phase is capped and affordable, but a cancer complication exposes you to uncapped Part B coinsurance—which is where supplemental coverage earns its keep.

A Concrete Cost Example

Consider two beneficiaries, each with well-controlled chronic hepatitis B taking a daily antiviral and seeing a hepatologist twice a year with annual ultrasound surveillance.

  • Maria takes generic entecavir, has Original Medicare with no supplement. Her drug copays run about $10 a month ($120/year), and her 20 percent coinsurance on two specialist visits plus an ultrasound and labs comes to roughly $200–$300 for the year. Her costs are modest and predictable—until any complication appears.
  • James needs brand-name Vemlidy because of kidney concerns with older antivirals. Without the cap, his coinsurance on that drug alone could exceed $1,500 a year, but the $2,000 Part D ceiling holds his total drug spend in check, and Extra Help would lower it further if he qualifies. If James later develops liver cancer requiring infused immunotherapy, his uncapped Part B coinsurance could jump into the thousands per year—which is exactly when his lack of a Medigap plan would hurt most.

The lesson: routine hepatitis B is affordable for both, but the complication scenario is what separates someone with supplemental coverage from someone facing open-ended bills.

Hepatitis B vs. Hepatitis C: A Key Difference

It’s worth being clear on how these two conditions differ under Medicare. Hepatitis C is usually curable—an 8-to-12-week course of direct-acting antivirals (Mavyret, Epclusa) clears the virus, and the $2,000 cap makes that cure newly affordable, as detailed in our hepatitis C guide. Hepatitis B is generally not curable; instead it is suppressed with lifelong daily antivirals. That means hepatitis B is a permanent, recurring cost rather than a one-time treatment—so the value of capped drug coverage and a good supplement compounds over many years rather than a single treatment window.

Cirrhosis and Advanced Liver Disease

If hepatitis B has already caused cirrhosis, Medicare covers the management of complications—treatment of varices, ascites, and hepatic encephalopathy. Some of these drugs (such as lactulose and rifaximin for encephalopathy) are Part D medications under the $2,000 cap; procedures and hospitalizations for complications fall under Part A and Part B. In the most advanced cases, a liver transplant may be considered, with its own extensive coverage rules and lifelong immunosuppressant drugs—covered the same way as any other organ transplant under Medicare.

Why Supplemental Coverage Still Matters

For stable, well-controlled hepatitis B, your biggest recurring cost is the 20 percent coinsurance on lifelong monitoring visits and imaging, plus the capped antiviral. That is manageable but constant. The real financial risk is a progression to liver cancer or cirrhosis complications, where uncapped Part B coinsurance on infused drugs and procedures can become severe.

  • Medigap Plan G pays that 20 percent with no annual limit, so both the routine surveillance and any future infused cancer therapy leave you owing essentially only the small Part B deductible.
  • Medicare Advantage caps annual in-network out-of-pocket but adds prior authorization and network limits—worth weighing if you rely on a specific liver specialist or transplant center. Compare the approaches in our Medicare Advantage vs. Original Medicare guide and the cost-focused breakdown.

Help With Costs

  • Extra Help (Low-Income Subsidy) sharply lowers Part D drug costs, which can bring even brand-name antivirals to very low copays.
  • Medicare Savings Programs can pay your Part B premium and, at the QMB level, your Part B coinsurance—relieving the recurring monitoring costs.
  • Manufacturer assistance is available for brand-name agents like Vemlidy for those who qualify.

The Bottom Line

Medicare covers chronic hepatitis B well: free screening and vaccine for at-risk beneficiaries, lifelong antiviral pills under Part D’s $2,000 cap, and liver cancer surveillance under Part B. The routine disease sits on the capped, affordable side of Medicare’s drug split. Your costs concentrate in two places—the recurring 20 percent coinsurance on lifelong monitoring, and the uncapped Part B exposure if the disease ever progresses to liver cancer. Pairing Medicare with Medigap Plan G (where affordable) and using Extra Help and Medicare Savings Programs is what keeps decades of hepatitis B care predictable. For the wider picture, see our guide to healthcare costs in retirement.