Medicare Coverage for Hepatitis C and Liver Disease: The Cure, Screening, and Costs

Hepatitis C is unusual among chronic diseases: it is now curable in most patients with a short course of oral pills. The catch has always been the price—those pills launched at roughly $1,000 a day, or about $84,000 for a 12-week cure. For years that sticker price kept the cure out of reach for many Medicare beneficiaries. The Inflation Reduction Act’s $2,000 annual cap on Part D drug costs changed that math entirely, and a hepatitis C cure is now genuinely affordable for people on Medicare. This guide explains how Medicare covers hepatitis C from screening through cure, and what it covers for the broader liver disease—cirrhosis, fatty liver, and liver cancer—that can follow.

Screening: Free for Those Who Qualify

Medicare covers hepatitis C screening at no cost—no deductible, no coinsurance—when ordered by a primary care provider for:

• Anyone with a history of injection drug use or other recognized risk factors, and
• A one-time screening for all adults born between 1945 and 1965 (the “baby boomer” cohort with the highest hepatitis C prevalence)

Because hepatitis C is often silent for decades, this free screening is the gateway to catching the infection before it causes irreversible liver damage. If you’ve never been tested and fall into either group, it costs you nothing.

Confirming and Staging the Disease Under Part B

Once an antibody screen is positive, follow-up testing moves to Part B at 80 percent after the $257 deductible (2026), leaving you 20 percent coinsurance:

• HCV RNA viral load and genotype testing to confirm active infection — clinical lab tests, generally no coinsurance
• Liver fibrosis assessment — FibroScan (transient elastography), ultrasound, or blood-based fibrosis panels — 20 percent coinsurance
• Hepatology or gastroenterology visits — 20 percent coinsurance

The Cure: Direct-Acting Antivirals Under Part D

The treatment that cures hepatitis C is a course of direct-acting antivirals (DAAs)—oral pills taken for 8 to 12 weeks. Because they are dispensed by a pharmacy and taken at home, they fall under Part D:

• Glecaprevir/pibrentasvir (Mavyret) — typically 8 weeks
• Sofosbuvir/velpatasvir (Epclusa) — typically 12 weeks
• Ledipasvir/sofosbuvir (Harvoni) and others

These drugs carry list prices in the range of $24,000–$90,000 for a full course, but because they run through Part D, your out-of-pocket is capped at $2,000 for the year (2026) under the Inflation Reduction Act. In practice, the entire cure now costs a Medicare beneficiary no more than $2,000—and often less with assistance. Before 2025, the same patient could have faced many thousands of dollars in the old coinsurance-heavy “donut hole” structure. This is one of the clearest examples of how the Part D cap turned a financially out-of-reach treatment into an affordable one. See Medicare Part D explained for how the cap works.

A practical tip: because the cap resets each calendar year, and a DAA course is a one-time cost, timing the start of treatment so the bulk falls in a single plan year keeps your total at a single $2,000 rather than splitting it across two years. Your prescriber and Part D plan can help coordinate this.

Extra Help makes it nearly free

If your income and assets are limited, Extra Help (the Part D Low-Income Subsidy) reduces specialty-drug copays to a few dollars, bringing a hepatitis C cure within reach of nearly anyone. Foundation grants and manufacturer programs further reduce costs. See Medicare Savings Programs, which can also qualify you automatically for Extra Help.

When the Liver Is Already Damaged: Cirrhosis and Its Complications

If hepatitis C—or alcohol-related liver disease, or metabolic dysfunction–associated steatotic liver disease (MASLD/NAFLD), the fast-growing fatty liver condition—has progressed to cirrhosis, Medicare covers ongoing management:

• Hepatology visits, labs, and imaging to monitor liver function — Part B, 20 percent coinsurance
• Upper endoscopy to screen for and band esophageal varices — Part B (diagnostic), 20 percent coinsurance
• Paracentesis to drain ascites fluid — Part B, 20 percent coinsurance
• Medications for complications — lactulose and rifaximin for hepatic encephalopathy, diuretics for ascites, beta-blockers for varices — all Part D (rifaximin/Xifaxan is the notable expensive one, but capped at $2,000)
• Hospitalization for decompensation (variceal bleeding, severe encephalopathy) — Part A, subject to the $1,676 (2026) deductible and the two-midnight rule

Even after a hepatitis C cure, patients with established cirrhosis still need lifelong monitoring, because cirrhosis itself carries an ongoing cancer risk.

Liver Cancer Surveillance and Treatment

Patients with cirrhosis are at elevated risk for hepatocellular carcinoma (liver cancer) and need surveillance ultrasound (often with AFP blood test) every six months—covered under Part B at 20 percent coinsurance.

If liver cancer develops, treatment follows the familiar Medicare drug-cost split (see Part B vs. Part D drugs):

• Locoregional procedures — ablation, transarterial chemoembolization (TACE), and radioembolization (Y-90) — Part B, 20 percent coinsurance, often with an inpatient or outpatient hospital component
• Infused immunotherapy — atezolizumab (Tecentriq) plus bevacizumab (Avastin), or durvalumab (Imfinzi) plus tremelimumab — Part B at 20 percent with no annual cap (the large, uncapped exposure)
• Oral targeted therapy — sorafenib, lenvatinib (Lenvima), regorafenib, cabozantinib — Part D, capped at $2,000

As with other cancers, the infused immunotherapy under Part B carries no cap, which makes a Medigap Plan G policy the decisive financial protection. See also Medicare cancer treatment coverage.

Liver Transplant

For end-stage liver disease or eligible liver cancer, Medicare covers liver transplantation when performed at a Medicare-approved transplant center:

• The transplant surgery and hospitalization fall under Part A
• Physician services fall under Part B at 20 percent coinsurance
• Anti-rejection (immunosuppressant) drugs are covered under Part B at 20 percent coinsurance when Medicare paid for the transplant—an important and often-misunderstood benefit, since these drugs must be taken for life

Because transplant care and lifelong immunosuppression generate large, recurring Part B coinsurance with no cap, supplemental coverage matters enormously here too.

Why Medigap or an MA Cap Still Matters

Hepatitis C itself is now a capped, affordable Part D cure—but the liver disease that can surround it (cirrhosis complications, liver cancer immunotherapy, transplant immunosuppressants) generates uncapped Part B exposure. That makes the standard protections relevant:

• Medigap Plan G pays essentially all Part B coinsurance after the small deductible—best secured during your six-month open enrollment window at 65, before liver disease is on your record. See Medigap plans compared and the supplement vs. Advantage comparison.
• Medicare Advantage caps in-network out-of-pocket (2026 max $9,250) but adds prior authorization and network limits—significant if you need a specific transplant or cancer center. See Medicare Advantage vs. Original Medicare.

The Bottom Line

Medicare’s coverage of hepatitis C is a genuine good-news story: free screening for at-risk groups and baby boomers, and a curative course of pills capped at $2,000 a year under Part D—a treatment that was financially out of reach a few years ago. The cure is the affordable part.

The larger financial risk lies in the liver disease that can come before or after—cirrhosis complications, liver cancer immunotherapy, and transplant—where uncapped Part B coinsurance can run high. As with every high-cost Medicare condition, securing Medigap Plan G during your open enrollment window is the strongest protection. For the full picture of lifetime medical costs, see healthcare costs in retirement.