Medicare may cover medically necessary dermatology services, such as the removal or treatment of cancerous skin lesions.
When Medicare covers dermatology services, Part B usually provides the 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 Part B covers medically necessary dermatological treatments, services, and screenings.
A person should visit their primary care physician before seeing a dermatologist. The physician can provide a referral based on medical necessity.
Part B does not cover cosmetic services. This can include treatments for age spots or wrinkles. However, some Medicare Advantage plans, also known as Part C, may cover some additional dermatological services.
Private companies sell Advantage plans. They need to provide the same coverage as Medicare Parts A and B, and they can also provide other coverage. For this, they may charge additional fees.
A person with an Advantage Plan should check with their insurance provider for more information about their coverage.
Be sure to confirm the coverage with a dermatologist who accepts Medicare insurance. Medicare’s Physician Compare tool can help a person find an appropriate dermatologist in their area.
A person with an Advantage plan may need to visit an in-network dermatologist or receive a referral from their primary care physician.
Taking these steps helps keep out-of-pocket costs as low as possible.
The following sections describe some of what Medicare covers for people who need dermatological care.
If a doctor deems it necessary, Medicare Part B typically covers a skin biopsy to check for cancerous tissue.
If a doctor finds cancer, Medicare covers the treatment, though a person is still responsible for deductibles and coinsurance costs.
Medicare Part B covers one full-body exam within the first 12 months of coverage. A doctor gives this exam to prevent future health problems.
Some Advantage plans may cover the costs of preventive screenings and services. If a person is unsure, they can contact Medicare or their Advantage plan administrator to confirm what their policy covers. People can also check their coverage here.
To help reduce the risk of cancer, many organizations offer free skin cancer screenings. Some options may include participating in the American Academy of Dermatology’s Skin Cancer Screening Program or the Destination Healthy Skin program.
The coverage for prescription drug-based dermatological treatments varies, depending on a person’s plan.
Medicare Part D covers prescription medications, but a person is not automatically enrolled in it. The costs of a Part D plan vary, depending, in part, on the medications that the doctor prescribes.
Each plan has a “formulary,” a list of medications that it covers, and these are categorized in tiers. In general, lower-tiered medications cost less than higher-tiered medications. A person can ask their doctor to prescribe a generic version of a drug, which may be cheaper, or a specific alternative that is included in their formulary.
Medicare covers services to treat skin-related medical conditions but does not usually cover cosmetic services or many full-body preventive exams.
Examples of services considered cosmetic include treatment for acne, wrinkles, and other signs of aging. However, there can be exceptions, depending on a person’s plan and their skin condition.
In addition, Medicare does not usually cover mole removal for cosmetic reasons. In other words, if a dermatologist is not concerned that a mole may be cancerous, Medicare does not cover the removal.
Also, Medicare Part D does not usually cover prescription medications to promote hair growth or other medications that address concerns considered cosmetic.
As always, it is important to check ahead of time whether a service or procedure is covered. A person may also need to obtain prior authorization from Medicare or their Advantage plan administrator to ensure that their plan will cover the costs.
When Medicare Part B covers dermatological services, the Part B deductible, which is $203 in 2021, still applies. A person usually also pays Part B coinsurance, which is 20% of the Medicare-approved amount for dermatological services.
If the healthcare professional involved does not agree to Medicare’s rates, the out-of-pocket cost may be higher.
If a person has an Advantage plan, they may pay a copayment for seeing a specialist when they visit a dermatologist. This fee depends on the plan and whether the dermatologist is a member of the insurer’s network.
Medicare Part D plans usually cover the costs of prescribed medications. These costs vary, based on the plan’s list of covered medicines. A person should be sure that any drugs that their dermatologist prescribes are on their plan’s list. The insurer provides this information.
If a person has Medicare supplement insurance, also called Medigap, this can help cover some of the copayments and deductibles relating to dermatology costs. However, the specific coverage depends on a person’s Medigap plan.
Dermatological services can be crucial for a person as they age, especially those used to detect and treat skin cancer. Medicare covers most costs relating to skin cancer and other skin conditions, such as psoriasis, rosacea, and eczema.
Medicare does not cover most preventive full-body exams or cosmetic treatments.
Before having a procedure, make sure that the dermatologist accepts the assignment from Medicare or is an in-network provider.