Georgia Medicare Hepatitis C Screening 2026 Guide

Hepatitis C is now a curable infection, and Medicare pays the full cost of finding it, but only for the people its coverage rule names. If you have Medicare and you were born between 1945 and 1965, or you have a risk factor Medicare recognizes, a provider can order a Hepatitis C screening test that costs you $0, with no deductible and no copay.1,2 This guide explains who qualifies, what the test costs, and how a positive result leads to treatment that clears the virus in Georgia.

Who Qualifies for Georgia Medicare Hepatitis C Screening?

Medicare covers Hepatitis C Virus (HCV) screening under National Coverage Determination (NCD) 210.13. A National Coverage Determination is a nationwide Medicare policy that applies the same way in every state and binds the contractors who process claims, so the rules below hold in Georgia exactly as they do everywhere else.4

A provider has to order the test, and then there are two ways to qualify:

• You are at high risk. Medicare treats you as high risk if you use or have used illicit injection drugs, or if you had a blood transfusion before 1992.1
• You were born between 1945 and 1965. If you fall in that birth cohort and are not otherwise high risk, Medicare still covers a screening test.1

How often Medicare pays depends on which door you came through. Screening is covered once a year only if you are high risk because you have continued to use illicit injection drugs since your previous negative Hepatitis C screening. In every other case, including past injection drug use, a pre-1992 blood transfusion, and the 1945-to-1965 birth cohort without high risk, the benefit is a single screening in your lifetime.1

If you have already used the once-in-a-lifetime screening and do not have continued injection drug use, Medicare generally will not pay for another routine screening. If your earlier screening cannot be documented, you can be treated as never-screened and get the one-time test.

The 2020 USPSTF Grade B Recommendation Did Not Widen Medicare's Rule

This is the point most Hepatitis C guidance gets wrong, so it is worth stating plainly. In March 2020 the U.S. Preventive Services Task Force (USPSTF) issued a Grade B recommendation to screen all adults age 18 to 79 once for Hepatitis C. Medicare's own coverage rule did not follow. NCD 210.13 still ties coverage to risk factors and to the 1945-to-1965 birth cohort, so a Medicare beneficiary born after 1965 with none of the listed risk factors is outside the screening benefit.1

That distinction matters when you ask for the test. Clinical guidance and Medicare payment rules are two different things: a provider may agree that screening you is good medicine and still find that Medicare will not pay for it. If you are outside the birth cohort and have no recognized risk factor, ask what the test costs as a self-pay lab draw, and ask your provider or the Georgia Department of Public Health about community testing.

The 1945-to-1965 Birth Cohort in Georgia

Birth year is one of the two doors into Medicare's screening benefit, and it matters medically as well. Adults born between 1945 and 1965, now roughly age 61 to 81, carry much higher Hepatitis C rates than younger adults. Many were exposed decades ago, through blood transfusions received before 1992 (when routine screening of the blood supply began), earlier injection drug use, or healthcare exposures, and most carry no symptoms. Georgia has a large population in this group, which is why a one-time screen is worth asking about at your next visit if you have never had one.

What Does Georgia Medicare Hepatitis C Screening Cost?

Like other Medicare-covered preventive screenings, the Hepatitis C screening test is $0 to you when your provider accepts Medicare assignment. There is no Part B deductible and no coinsurance for the screening itself.2 This no-cost treatment of Grade A and B preventive services comes from federal law, and it applies whether you have Original Medicare or a Medicare Advantage plan.

The screening test is an HCV antibody blood test, billed under HCPCS code G0472. It can be drawn in a primary care visit, at your Annual Wellness Visit, or at any clinical encounter. Unlike some screenings, it does not require a special setting.

The Cost of the Follow-Up Test

Here is the part that surprises some beneficiaries. The free screening is only the antibody test. A positive antibody result means you have been exposed to Hepatitis C at some point, but it does not tell you whether the virus is still active. To find that out, you need a confirming HCV RNA test.

That confirming RNA test is a diagnostic test, not a screening, so it is billed under standard Part B rules: the Part B deductible if you have not met it, plus 20 percent coinsurance.2 Many labs run the RNA test automatically ("reflex" testing) on the same blood sample, so you do not need a second blood draw, but you may still see a separate diagnostic charge on your Medicare Summary Notice. If you have a Medicare Supplement (Medigap) policy, it typically covers this cost-sharing. If you have both Medicare and Medicaid, Medicaid covers the Part B cost-sharing as your secondary payer.

What Happens After a Positive Result?

A positive antibody test is not a diagnosis of active infection, and it is not a reason to panic. It is a signal to take one more step. The path is straightforward:

1. Confirm active infection. The HCV RNA test tells you whether the virus is still in your blood. If the antibody is positive but the RNA is negative, you cleared the infection on your own or were treated before, and you do not need treatment. Getting that documented in your record prevents repeated testing later.
2. See a clinician who treats Hepatitis C. If the RNA is positive, you have chronic Hepatitis C. Your primary care provider may treat it directly, or refer you to a hepatology (liver) or infectious disease specialist. In much of Georgia, primary care practices and Federally Qualified Health Centers now treat Hepatitis C themselves, sometimes with specialist backup by video.
3. Complete pre-treatment workup. This usually includes a check of how much the virus has scarred your liver (often a painless FibroScan), plus routine bloodwork and tests for HIV and hepatitis A and B.
4. Take the treatment. Direct-acting antiviral (DAA) medications are oral pills taken for about 8 to 12 weeks. They cure the vast majority of people who complete the course.
5. Confirm the cure. A blood test about 12 weeks after treatment ends (called a sustained virologic response, or SVR) confirms the virus is gone.

How Medicare Covers Hepatitis C Treatment

The screening and the cure are covered under different parts of Medicare, and knowing which is which helps you anticipate costs.

Direct-acting antiviral pills are covered under Medicare Part D, your prescription drug plan, not under Part B. Plans usually place these medications on a specialty tier and require prior authorization, meaning your prescriber documents your diagnosis before the plan approves the drug. List prices for a treatment course run into the tens of thousands of dollars, but you almost never pay that: Part D coverage, and for many people the Medicare Low-Income Subsidy (Extra Help), bring the cost down sharply.

The biggest recent change is a hard ceiling on what any Part D enrollee pays out of pocket. In 2026, once your out-of-pocket spending on covered Part D drugs reaches $2,100 for the year (the cap began at $2,000 in 2025), you pay $0 for covered drugs for the rest of the year.5 For a high-cost specialty medication like a Hepatitis C cure, that cap can be the difference between affordable and out of reach. If the early-year cost is still a strain, every Part D plan must offer the Medicare Prescription Payment Plan, which spreads your out-of-pocket costs into monthly installments.

For Georgians served by a Federally Qualified Health Center or a Ryan White HIV clinic, 340B drug pricing and manufacturer patient assistance programs can lower costs further.

Understanding Hepatitis C

Hepatitis C is a virus spread through blood-to-blood contact. The most common routes are shared injection-drug equipment and, historically, blood transfusions or organ transplants received before 1992, when routine screening of the blood supply began. Less common routes include healthcare-related needlestick exposures and transmission from mother to child during pregnancy or birth.

After someone is first infected, a minority of people clear the virus on their own within a few months. Most, though, develop a long-term (chronic) infection that can sit silently in the body for years or decades. Left untreated, chronic Hepatitis C is a leading cause of cirrhosis (liver scarring), liver cancer, and liver failure. A substantial share of people with untreated chronic infection go on to develop cirrhosis over two to three decades, and cirrhosis in turn carries an elevated yearly risk of liver cancer.

The reason screening matters so much is that treatment now works. Direct-acting antiviral pills, taken for a couple of months, cure nearly everyone who completes the course. Curing the infection lowers the risk of cirrhosis progression, liver cancer, and death. Being cured does not make you immune, though, so if you have ongoing risk you can be reinfected. That is why Medicare pays for yearly rescreening for the one group it names: people who have continued illicit injection drug use since their previous negative screening.1

Getting Screened and Treated in Georgia

Georgia carries a heavier Hepatitis C burden than much of the country, concentrated in the 1945-to-1965 birth cohort, in people with current or past injection drug use, in correctional and formerly incarcerated populations, in people with HIV, and in rural counties where treatment has been harder to reach. The Georgia Department of Public Health runs viral hepatitis surveillance and prevention statewide.

If you live in rural Georgia and worry there is no liver specialist nearby, you have real options. Tele-hepatology and the Project ECHO model connect local primary care providers with specialists by video, and many Federally Qualified Health Centers treat Hepatitis C on site. You do not necessarily have to travel to Atlanta to be cured.

Larger hepatology and liver-transplant programs across the state include those at Emory Healthcare, Wellstar, Piedmont, Augusta University Health, Atrium Health Navicent in central Georgia, and Memorial Health in Savannah. Georgians with both HIV and Hepatitis C can get coordinated care through Ryan White-funded HIV clinics.

What to Ask and What to Watch For

If you are not sure whether you have ever been screened, that is the first thing to ask your primary care provider. A few situations come up often:

• A screening claim was denied as a duplicate. The once-in-a-lifetime screening pays once. Yearly screening is covered only if you have continued illicit injection drug use since your last negative test, so ask your provider's billing staff to review whether that annual benefit applies to you.1
• You were born after 1965 and have no listed risk factor. Medicare's screening benefit does not reach you, even though the USPSTF recommends screening every adult 18 to 79 once. Ask your provider whether anything in your history counts as illicit injection drug use or a blood transfusion before 1992, and ask what a self-pay test would cost.1
• You cannot afford the confirming RNA test. The screening is $0, but the confirming diagnostic test carries standard Part B cost-sharing.2 Medigap, Medicaid (if you are dually eligible), or Extra Help can reduce or eliminate it. Federally Qualified Health Centers often use a sliding fee scale.
• Your drug plan denied the DAA prior authorization. Plans usually want documentation of your diagnosis and sometimes a liver-scarring assessment. Ask your prescriber to supply what the plan requires, and use the plan's appeal process if needed.
• A Medicare Advantage plan denied the screening. Medicare Advantage plans must cover HCV screening at least as fully as Original Medicare. Denials can be appealed through the plan, and pattern denials can be raised with Medicare and the Georgia Department of Insurance.

Worked Examples

The following are illustrative scenarios, not real individuals. Dollar amounts and clinical details are hypothetical and meant to show how coverage typically works.

Example 1: A Fulton County Retiree Screened at His Wellness Visit

A 66-year-old man in Atlanta goes to his Annual Wellness Visit and has never been screened. He was born in 1960, inside the 1945-to-1965 birth cohort, and he recalls a blood transfusion in 1985. Either one qualifies him, so his provider orders the HCV screening (G0472).1 The antibody test is positive, and a reflex RNA test confirms active infection. He is referred to a liver specialist, completes an 8-week course of DAA pills, and a follow-up test confirms he is cured. The screening cost him $0; his Medigap plan covered the confirming test's cost-sharing.2

Example 2: A Worth County Dual-Eligible Screened at an FQHC

A 70-year-old man in rural southwest Georgia has Medicare and Georgia Medicaid and a history of injection drug use decades ago. He gets primary care at a Federally Qualified Health Center, where his provider orders the HCV screening based on that past injection drug use. Because the drug use is in the past and has not continued, Medicare covers the screening once in his lifetime rather than yearly.1 The antibody test is negative. His cost is $0; as a dually eligible beneficiary, any cost-sharing would have been covered by Medicaid.2

Example 3: A Cobb County Medicare Advantage Member with a Negative Screen

A 69-year-old woman in a Medicare Advantage plan is screened at her wellness visit because she was born in 1957, inside the 1945-to-1965 birth cohort, even though she has no identified risk factors.1 The result is negative. Her screening is $0 in network.2 The case shows why the birth cohort rule exists: many people in it were exposed through events they do not remember.

Example 4: A DeKalb County Patient with HIV Coinfection

A 68-year-old man with well-controlled HIV has continued injection drug use, so Medicare covers a repeat screening each year after his last negative test.1 A new antibody positive prompts an RNA test that confirms infection. His hepatology and HIV teams pick a DAA regimen that avoids interactions with his HIV medications. He completes 12 weeks and is cured. Note that HIV coinfection on its own is not what unlocks the yearly screening under Medicare's rule; the continued injection drug use is.

Where to Get Help

Learn More

Find personalized help navigating Medicare Hepatitis C screening and treatment in Georgia at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.