Medicare covers medically necessary treatment for eczema. This includes phototherapy, as well as medications in the form of creams, pills, or injections.
Original Medicare with a Part D plan or an Advantage plan that includes prescription drug benefits may provide coverage, although there are out-of-pocket costs.
This article examines Medicare coverage of eczema and the out-of-pocket costs, along with programs that help pay the costs. Then, it discusses eczema and each type of treatment.
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.
Several parts of Medicare provide coverage for eczema in specific areas.
Original Medicare is composed of Part A, hospitalization insurance, and Part B, medical insurance. Because treatment of eczema does not require an overnight hospital stay, the coverage falls under Part B.
Coverage of Part B relating to eczema includes:
- doctor visits
- lab tests
- outpatient treatment
Medicare Advantage is the alternative to original Medicare, so the plans include the benefits of parts A and B. Many Advantage plans also offer prescription drug benefits, which would cover creams and pills for eczema.
A person with original Medicare does not have prescription drug benefits, but they may get this coverage with a Part D plan. Each plan includes medications in all the classes that doctors commonly prescribe, including those for eczema.
Out-of-pocket costs are the costs that Medicare does not cover and include deductibles, copays, and coinsurance. There is no limit to out-of-pocket costs for original Medicare (parts A and B.)
Eczema treatment does not fall under Part A coverage, so there are no costs in this area.
If a person gets treatment for eczema in an outpatient setting, 2021 Part B costs include:
Parts C and D
Parts C and D costs include deductibles, copays, coinsurance, and monthly premiums. These costs vary widely with the Part C or D plan and the company that offers it, although in 2021 Part D’s out-of-pocket maximum is $445 and part C’s out-of-pocket maximum is $7550. These might be lower depending on your plan.
Medicare offers several options to help with out-of-pocket costs.
- Medigap is Medicare supplement insurance, available to a person enrolled in original Medicare. The plans pay between 50%–100% of parts A and B costs, so they would help with Part B eczema treatment expenses.
- Extra Help provides assistance in paying Part D costs for people with limited income and resources. It helps with approximately $5,000 of medication expenses per year, which would assist with the cost of lotions and pills for eczema.
- Medicaid is a state-federal program that helps people with low-income pay healthcare costs.
- Medicare savings programs help individuals with low-income pay costs of certain parts of Medicare.
Eczema is a medical term for several types of rash-like skin conditions. Most types cause itchy, dry skin, but the condition is not contagious. If a person scratches the rash, the skin turns red and may itch more than before.
Eczema may produce a rash on the following body parts:
- inside the elbows
- behind the knees
Causes and complications
While eczema’s cause is not known, it may stem from both environmental and genetic factors.
Eczema is often chronic, but it can either worsen or get better with time. A person with the condition may also develop asthma and hay fever.
The most common type of eczema is atopic dermatitis. Although it often occurs in babies and children, adults may also develop the condition.
Eczema has no cure, but treatment includes lifestyle changes, such as:
- regular bathing and moisturizing
- avoiding scratching
- watching for signs of infection
However, despite lifestyle changes, a person may need treatment, which ranges from topical, oral, and injection medications to phototherapy.
Topical medications are applied to the skin in the form of a cream, lotion, or spray. The most common medications for eczema are steroids, phosphodiesterase 4 (PDE4) inhibitors, and topical calcineurin inhibitors (TCIs).
Corticosteroids, sometimes called steroids, reduce itching and inflammation, which promotes skin healing. They come in different potencies or strengths. Common side effects include:
- thinning of the skin
- spider veins
- inflammation of skin around the mouth
- stretch marks
- acne-like rashes
Topical phosphodiesterase 4 inhibitors
The PDE4 inhibitors block an enzyme involved in the inflammation of eczema. Crisaborole, sold under the brand name, Eucrisa, is an ointment that can reduce signs and symptoms of atopic dermatitis, such as redness, itching, and thickened skin. The most common side effect is stinging or burning upon application.
Topical calcineurin inhibitors (TCIs)
Medications called TCIs stop some immune system cells from switching on, which can prevent itching, redness, and inflammation. Two TCIs are available.
Pimecrolimus cream is sold under the generic form or brand name, Elidel.
Tacrolimus ointment is sold under the generic form or brand name, Protopic.
Common side effects are mild burning or stinging when a person first applies the medications to the skin.
Oral medications are drugs that someone takes by mouth, and are then absorbed into the bloodstream. The oral drugs for eczema are immunosuppressants, medications that prevent overreaction of the immune system. These fall into two categories: traditional immunosuppressants and steroids.
Some of the most frequently prescribed immunosuppressants are:
- mycophenolate mofetil
Because of possible complications, doctors generally only prescribe immunosuppressants for a short time until the eczema is under control. The medication may cause serious side effects, such as:
- nausea and vomiting
- increased risk of infections
- increased risk of some types of cancer
For people with a severe case of eczema, doctors may prescribe an oral steroid, such as prednisone, to control inflammation. However, the drugs may have a rebound effect, where the symptoms return and may worsen after a person discontinues their use.
Long-term use of oral steroids may have serious side effects, such as:
- increase in infections
- weight loss
- high blood pressure
- weakening of bones
- gastrointestinal problems
Biologic drugs, also called biologics, use human DNA to treat conditions involving immunity. They help prevent the overreaction of the immune system, which results in less inflammation and reduced symptoms of atopic dermatitis. The drugs are injected through the skin or into a vein.
The Food and Drug Administration (FDA) has approved the biologic drug, dupilumab, sold under the brand name, Dupixent. Doctors prescribe it for people with moderate to severe atopic dermatitis when topical treatments do not manage the condition well.
Common side effects include:
- injection site reactions
- pink eye
- cold sores on the mouth
Phototherapy, or light therapy, involves treatment with different wavelengths of ultraviolet light. The most common form for eczema is ultraviolet B (UVB) light, but another option is ultraviolet A (UVA) light.
Doctors use UVB or UVA light to reduce the itching and inflammation of many types of eczema. They generally prescribe it for people with eczema that has spread all over the body, and individuals with eczema that is limited to a certain body part, such as the hands, but has not improved with topical drugs
Possible side effects include:
If people have original Medicare, Part B covers the eczema treatment of phototherapy and injections. To get Medicare coverage of pills and lotions, a person would need a Part D plan, which provides prescription drug benefits.
A person with an Advantage plan also receives coverage of phototherapy and injections because the plans must provide at least the basic coverage of original Medicare. If an Advantage plan includes prescription drug benefits, it will cover eczema pills and lotions.
We will update the 2021 costs as soon as possible after the Centers for Medicare and Medicaid Services (CMS) have released them.
We last updated the costs on this page on October 29, 2020.