Hepatitis B is a virus that attacks the liver and can cause chronic liver disease. Hepatitis B shots can help prevent the disease.
Medicare Part B covers the hepatitis B vaccine if you are at medium or high risk for hepatitis B. Medicare considers you at medium or high risk if you:
- Have End-Stage Renal Disease (ESRD)
- Have hemophilia
- Are a client of or staff member at an institution for the developmentally disabled
- Live in the same household as a hepatitis B carrier
- Have unprotected sex with multiple partners or with someone who has hepatitis B
- Use certain federally prohibited substances
- Are a health care professional in frequent contact with blood or other body fluids during routine work
Note: If you are at low risk for hepatitis B, the shot will be covered under Part D.
If you qualify, Original Medicare covers hepatitis B shots at 100% of the Medicare-approved amount when you receive the service from a participating provider. This means you pay nothing (no deductible or coinsurance). Medicare Advantage Plans are required to cover hepatitis B shots without applying deductibles, copayments, or coinsurance when you see an in-network provider and meet Medicare’s eligibility requirements for the service.
During the course of your hepatitis B shot, your provider may discover and need to investigate or treat a new or existing problem. This additional care is considered diagnostic, meaning your provider is treating you because of certain symptoms or risk factors. Medicare may bill you for any diagnostic care you receive during a preventive visit.
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