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Seen & Heard Team
Why is Medicare reconsidering hepatitis C screening?
A person's age or medical history can affect whether Medicare covers a hepatitis C screening test. That could change.
On September 23, CMS announced a national coverage analysis to reconsider its existing screening policy after receiving five formal requests from healthcare organizations and advocates.
The review comes more than six years after the U.S. Preventive Services Task Force (USPSTF) expanded its screening recommendation to include all adults ages 18 to 79.
Medicare's existing national coverage policy remains narrower, relying on specific birth years and risk factors to determine eligibility.
The difference raises an important question: If medical experts recommend that nearly every adult get screened, should Medicare's national coverage policy reflect that guidance?
CMS is now evaluating that question, including whether screening should be covered in more healthcare settings and how frequently people with ongoing risk factors should be tested.
Who currently qualifies for hepatitis C screening under Medicare?
Under the existing national coverage determination, Medicare covers hepatitis C screening for eligible beneficiaries in two primary groups.
The first includes adults considered at high risk for hepatitis C infection. CMS identifies high-risk individuals as people with a current or past history of illicit injection drug use or those who received a blood transfusion before 1992.
The second includes adults born between 1945 and 1965 who do not meet the specified high-risk criteria. Those individuals qualify for a one-time screening.
Repeat annual screening is covered for certain high-risk beneficiaries who have continued injection drug use since their previous negative screening.
The policy also specifies that screening must be ordered by an eligible primary care physician or practitioner within a primary care setting.
These requirements reflect an earlier approach to hepatitis C detection.
In March 2020, the USPSTF recommended screening all adults ages 18 to 79, regardless of whether they have known risk factors. The Centers for Disease Control and Prevention (CDC) also recommends screening nearly all adults at least once during their lifetime.
Why does hepatitis C screening matter?
Hepatitis C is a viral infection that affects the liver. Without treatment, chronic infection can lead to liver damage, cirrhosis, liver cancer, and death.
One of the challenges is that people can live with the infection for years without knowing it.
According to the CDC:
- Nearly one in three people with hepatitis C are unaware they have the infection.
- Approximately 75% to 85% of people with hepatitis C experience no symptoms.
- Testing and timely treatment can prevent serious complications and reduce transmission.
These realities make early detection important.
A patient can feel healthy, visit a healthcare provider for an unrelated concern, and still have an undiagnosed infection.
Routine screening creates an opportunity to identify the infection before more serious complications develop.
Treatment has also improved. Most hepatitis C infections can now be cured with an 8- to 12-week course of oral antiviral medication.
Yet treatment begins with knowing an infection exists.
Why this matters: The connection between coverage and health equity
Medicare's review is about more than one screening test. It raises a broader question about how healthcare policy influences access to preventive care.
Clinical recommendations tell healthcare professionals what services patients should receive. Coverage policies influence which services are paid for and under what circumstances.
When the two do not align, patients and providers may face uncertainty about whether recommended care will be covered.
This matters for people who do not consistently receive care in traditional primary care settings.
Consider someone receiving services through a substance use treatment program or a community-based healthcare organization. That individual may benefit from routine hepatitis C screening but face challenges navigating the healthcare system or accessing a primary care provider.
CMS is specifically seeking evidence about screening in non-primary-care settings.
For federally qualified health centers, community health workers, care coordinators, and patient navigators, the issue extends beyond identifying who needs testing.
It includes helping patients complete testing, understand results, connect with treatment, and remain engaged in care.
If Medicare broadens its coverage criteria, organizations may have more opportunities to integrate screening into existing care workflows.
But expanding coverage does not automatically guarantee access.
Patients may still face transportation challenges, limited appointment availability, difficulty understanding medical information, and barriers to follow-up care.
A stronger screening policy would need to work alongside efforts that help people move from diagnosis to treatment.
What could change if Medicare expands coverage?
CMS has not announced a final decision, but its review identifies several areas that could change.
The most significant possibility is expanding coverage to align more closely with the USPSTF recommendation for adults ages 18 to 79.
That could reduce reliance on birth-year eligibility and a narrow set of risk factors.
CMS is also considering evidence about how often people with ongoing exposure risks should be screened.
The agency has expressed particular interest in whether screening should be supported beyond traditional primary care settings.
Each of these questions could influence how healthcare organizations identify eligible patients and deliver preventive services.
For health systems and community health centers, changes could require updates to clinical workflows, electronic health record screening reminders, billing procedures, and staff education.
Those operational implications remain possibilities rather than confirmed requirements.
What happens next?
CMS opened its public comment period on September 23, 2026. Comments will be accepted through October 23.
The agency is seeking scientific evidence, including research on appropriate screening intervals for people with ongoing risk factors and screening outside primary care.
A proposed decision memorandum is scheduled for March 23, 2027.
CMS expects to complete its national coverage analysis by June 21, 2027.
Healthcare organizations, clinicians, researchers, and advocates can submit comments through the official CMS coverage analysis page.
Until CMS issues a final decision, the existing national coverage determination remains in place.
The bigger picture
The Medicare review points to a recurring issue in American healthcare: Medical evidence, clinical recommendations, and payment policies do not always advance at the same pace.
For patients, those differences can create uncertainty about access to recommended preventive services.
For healthcare organizations, they can complicate decisions about which screenings to offer, when to offer them, and how to ensure patients receive the necessary follow-up care.
The hepatitis C review offers an opportunity to reconsider that relationship.
The ultimate measure of a successful policy change should not be limited to how many additional people become eligible for screening.
It should also consider how many infections are detected earlier, how many patients receive appropriate treatment, and whether people who have historically faced barriers to healthcare are better served.
A coverage change can open the door to care. The healthcare system still has to help people get through it.
Frequently asked questions
Does Medicare cover hepatitis C screening?
Yes. Medicare currently covers hepatitis C screening for eligible beneficiaries based on certain risk factors or birth years, subject to other coverage requirements. CMS is reviewing whether those criteria should be expanded.
Does Medicare cover hepatitis C screening for everyone ages 18 to 79?
Not under its current national coverage determination. Although the USPSTF recommends screening adults ages 18 to 79, Medicare's national coverage criteria remain more restrictive. CMS is considering whether to change them.
Why is hepatitis C screening important if someone has no symptoms?
Many people with hepatitis C experience no symptoms. Screening can identify an infection before serious liver damage develops and help connect patients with treatment.
When will Medicare make a decision about hepatitis C screening?
CMS has scheduled a proposed decision memorandum for March 23, 2027, and expects to complete the review by June 21, 2027. These are anticipated dates, not guarantees.
How can healthcare organizations provide input?
CMS is accepting public comments through October 23, 2026. Organizations can submit clinical evidence, research, and other relevant feedback through the agency's official coverage analysis page.
Primary sources
CMS — National Coverage Analysis CAG-00436R
September 23, 2026 · Official policy review and public comment dates
USPSTF — Hepatitis C Screening Recommendation
March 2, 2020 · Clinical screening recommendations
CDC — Clinical Screening and Diagnosis for Hepatitis C
January 31, 2025 · Screening guidance and clinical evidence