Medicare Beneficiaries and Vaccination to Prevent Hepatitis B

What is Hepatitis B?

Hepatitis is a group of diseases that affect the liver. There are several types of hepatitis; the most common one in the United States is hepatitis B. Hepatitis B is caused by a virus which is the root cause of about 125,000 new infections each year. There are over a million people infected by hepatitis B virus in the United States.

This disease is easier to catch than AIDS, and like AIDS it is transmitted through infected blood and other body fluids (seminal fluid, vaginal secretions, breast milk, tears, saliva and open sores). You can pick up the virus when you:

• Have contact with blood and body fluids through breaks in your skin if you are bitten by an infected person and/or by touching open cuts or sores on the infected person's body
• Have contact with objects that could have blood or body fluids on them, for example toothbrushes or razors, or by the sharing of diabetes blood testing equipment
• Have unprotected sex with an infected person
• Share needles when injecting medicines or drugs

Most people who get hepatitis B do not have any symptoms. A hepatitis B infection can make you mildly sick and lasts only a few weeks, or cause severe illness that lasts a lifetime. Symptoms of hepatitis B include the following:

• Loss of appetite
• Nausea and vomiting
• Fever
• Weakness, tiredness, lasting weeks or even months
• Abdominal pain
• Dark urine
• Yellowing skin and eyes (jaundice)

Does everybody need to be vaccinated for Hepatitis B?

All unvaccinated adults will benefit by getting a hepatitis B vaccination. It will protect you from hepatitis B and its possible serious consequences. This can include a lifetime of illness, liver cancer and cirrhosis. Routine immunizations for hepatitis began in 1991. Since then, the reported new cases of hepatitis B infections have dropped by 75% in all age groups.

While any adult who is vaccinated will benefit, there are people who have a higher chance of being exposed to the virus and should definitely consider getting vaccinated, those include:

• Older adults - due to the increased likelihood of hospitalization and/or time in a nursing home
• People over 65 - due to the increased risk of having serious health problems as a result of a hepatitis B infection
• Patients and workers in hospitals, nursing homes, mental institutions
• Morticians
• People on dialysis
• People who have a history of using injected drugs
• People receiving treatments or who have conditions that suppress the immune system (cancer treatments, diabetes, lung conditions, etc.)

Benefits of the immunization include the:

• Prevention of serious illness and health problems or even death
• Prevention of the suffering and costs associated with a hepatitis B infection

Any adult who is at risk for hepatitis B virus infection or who wants to be vaccinated should talk to their health care provider about getting the vaccine series. The hepatitis B vaccine is usually given as a series of 3 or 4 shots. For most people they will provide lifelong protection.
People who should not have the hepatitis B shot include those who:

• Have an allergy to baker’s yeast
• Have had a allergic reaction to a previous shot of the vaccine
• Are moderately or severely ill when a dose of vaccine is scheduled.

Wait until you are better before getting the vaccine. Your health care provider can give you more information about these precautions.

Is the vaccine safe?

Yes, the hepatitis B vaccine is very safe. More than a 100 million people have gotten the vaccine in the United States and serious problems have been extremely rare. Mild reactions to the vaccine are more common. They include:

• Soreness where the shot was given (up to about 1 person in 4)
• Mild temperature (up to about 1 person in 15)

Does Medicare pay for the vaccine?

Yes, Medicare will cover the hepatitis B shots (vaccine) for all people covered by Medicare who are at medium to high risk for hepatitis B. You should discuss your risks for hepatitis B with your doctor or health care provider. The benefit is covered by Medicare Part B.

What does it cost? 

• You will pay 20% of Medicare-approved amounts for the hepatitis B vaccine when it is given in a doctor's office
• If the hepatitis B shot is given in a hospital outpatient department, you pay a set copayment amount.
• If you have a Medicare Advantage plan, you should call your plans service line to find out what they cover and how you qualify for the benefit. (They must cover at least what Medicare does – they may cover more).
• If you have a Medigap plan, you may pay little to nothing out of pocket after Medicare pays its part. Be sure to talk to the provider of services to see if you will have additional costs.

Where do I get the Hepatitis B vaccination? 

The best place to get a hepatitis B vaccination is at your doctor’s office. However, you can also get your shots from the nurse that provides your home health care or the health care provider at your assisted living facility. They must have a written order from your doctor in order for Medicare to cover the costs.