Medicare may cover medically necessary dermatology services, such as the removal or treatment of cancerous skin lesions.
In the instances where Medicare does cover dermatology services, Medicare Part B is usually the portion that provides coverage.
In this article, we detail which dermatology services Medicare typically covers and which it excludes.
We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:
- Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
- Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
- Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Medicare covers medical services that provide active treatment for medical conditions. For dermatology, this may include diagnostic services and treatments that address conditions affecting:
- the hair
- the mucous membranes
- the nails
- the skin
According to an article in
The authors also found that the most common dermatological procedure that Medicare funded for enrollees was the destruction of precancerous lesions.
To confirm coverage, a person must receive care from a dermatologist who accepts Medicare. Medicare’s Physician Compare tool can help a person find a dermatologist in their area.
People with a Medicare Advantage plan may need to visit an in-network dermatologist or receive a referral from their primary care physician.
Taking these steps will ensure that a person can receive dermatological care at the lowest possible cost.
If Medicare Part B covers dermatology services, a person will usually pay the Part B coinsurance. This coinsurance is 20% of the Medicare-approved amount for the dermatology services.
The Part B deductible also applies. For the year 2020, the Part B deductible is $198.
If a person has Medicare Advantage, they may pay their copayment for seeing a specialist when they visit a dermatologist.
This fee depends on a person’s Medicare Advantage plan, as well as whether the dermatologist is a member of the insurer’s network.
Other dermatology costs may include prescribed medications for skin conditions. Medicare Part D plans usually cover these costs. Costs are different for generic and brand name drugs.
People should make sure that any drugs that their dermatologist prescribes are on their plan’s formulary, or list of included medications. An insured person can check their formulary directly with their insurer.
If a person has Medicare supplement insurance or Medigap, they may be able to use the policy to help pay for some of the copayments or deductibles relating to Medicare dermatology costs.
However, the contribution that Medigap plans will make toward these costs depends on a person’s policy.
Full body checkups are a preventive service during which a dermatologist examines a person’s skin, hair, and nails for signs of melanoma or other precancerous skin lesions.
Some people may choose to get these as annual skin checkups.
Original Medicare does not cover most full body checkups because they are preventive. This term means that a doctor carries them out to prevent future health problems rather than to treat an active medical concern.
However, some Medicare Advantage plans may cover preventive dermatology services, depending on the insurer. A person should review their plan carefully to check that it meets their healthcare needs.
Medicare Part B will usually cover skin biopsies when a person has noticed suspicious skin-related symptoms.
Part B’s coinsurance of 20% and the deductible will apply. A person may also receive a separate bill for laboratory costs.
A dermatologist may take a skin biopsy to check the skin’s health. This procedure involves taking a sample of skin and sending it to a laboratory for testing. A doctor may perform a skin biopsy when a person has a mole that has changed in appearance or any other suspicious lesions.
If the results confirm the presence of cancerous cells, a dermatologist may have to remove a larger portion of the skin to remove all of the malignant cells. If the affected area is very large, a person may require a referral to a surgeon for removal.
However, if a person has a question about coverage for a specific condition, they can contact Medicare or their Medicare Advantage plan administrator to confirm that their policy will treat their condition.
People can also check their cover here.
A doctor may sometimes prescribe medications to treat these conditions. The covered medications may depend on the prescription drug coverage that a person’s plan provides.
Medicare requires that all people aged 65 years and above have some form of creditable drug coverage.
If a doctor prescribes a medication, a person should check their formulary to determine whether Medicare will pay for the drug.
Medicare covers services to treat skin-related medical conditions but will not usually cover services for cosmetic purposes.
Examples include treatment for acne or wrinkles and other signs of aging. However, exceptions may apply if a person’s plan specifies them, or if they have a unique skin problem.
The individual may wish to obtain prior authorization from Medicare or their Medicare Advantage administrator to ensure that their plan will cover the costs.
Medicare will not usually cover mole removals for cosmetic reasons. If a dermatologist does not have concerns that the mole may be cancerous, the insured person is responsible for funding its removal.
Medicare Part D does not usually cover prescription medications to promote hair growth or other medications that people may require for cosmetic purposes.
Dermatology services can be important for a person as they age, especially for the detection and treatment of skin cancer.
Treating other skin conditions, such as psoriasis, rosacea, or eczema, is also important. Medicare covers most costs relating to the diagnosis and treatment of skin conditions.
However, Medicare does not cover preventive full body exams or cosmetic treatments.
A person should ensure that their dermatologist accepts assignment from Medicare or is an in-network provider for their particular plan.