Key takeaways
- Original Medicare and Medicare Advantage plans cover inpatient and outpatient care for skin cancer, though out-of-pocket costs are likely.
- While Medicare does not pay for skin cancer screening, it does cover doctor visits if a person notices suspicious changes to their skin.
- Medicare provides coverage for the removal of precancerous skin lesions (actinic keratoses) through various treatment methods, including cryosurgery, topical chemotherapy drugs, curettage, and photodynamic therapy.
There are three major types of skin cancer: basal cell carcinoma, squamous cell carcinoma, and melanoma. Early detection and treatment of skin cancer is important. Although Medicare does not pay for screening, it does cover a visit to a doctor’s office if a person notices a suspicious change to their skin.
Medicare also covers the destruction of precancerous skin lesions, or actinic keratoses.
This article will discuss what Medicare covers for early detection in place of skin cancer screening. It will also examine the out-of-pocket costs for skin cancer and provide an overview of some methods that doctors use to diagnose and treat it.
Glossary of Medicare terms
- Out-of-pocket cost: This is the amount a person must pay for care when Medicare does not pay the total amount or offer coverage. Costs can include deductibles, coinsurance, copayments, and premiums.
- Premium: This is the amount of money someone pays each month for Medicare coverage.
- Deductible: This is an annual amount a person must spend out of pocket within a certain period before Medicare starts to fund their treatments.
- Coinsurance: This is the percentage of treatment costs that a person must self-fund. For Medicare Part B, coinsurance is 20%.
- Copayment: This is a fixed dollar amount a person with insurance pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Medicare does not cover screening if a person does not have any symptoms of skin cancer. However, if someone notices new skin growth or a change in the appearance of a mole, Medicare will cover a visit to the doctor.
If a doctor notices a possible sign or symptom of skin cancer during an exam for something unrelated and thinks that it warrants investigation, Medicare may pay more for the visit.
In either of the above scenarios, a doctor may refer a person to a dermatologist to check out a skin irregularity. Medicare will also cover these visits. A dermatologist is a doctor who specializes in the diagnosis and treatment of skin disorders, a field known as dermatology.
In addition to the initial visit to a doctor, Medicare provides broad coverage for skin cancer. The following sections will look at the different options available.
Original Medicare
With Original Medicare, Part A covers inpatient hospital stays, and Part B covers outpatient treatment and care.
Part A covers surgery and other skin cancer treatments a person receives during a hospital stay. It also covers blood work, hospice care, and home healthcare, such as physical therapy.
Part B covers doctor visits, outpatient surgeries, outpatient radiation therapy, and diagnostic tests, such as X-rays. Coverage also includes many chemotherapy drugs a person receives intravenously.
Part D
Part D, also known as a prescription drug plan (PDP), works alongside Original Medicare.
The policies cover most medications and some oral chemotherapy drugs. If a person’s Part B does not cover a cancer drug, their Part D plan may cover it.
Medigap
Medigap is Medicare supplement insurance, which someone with Original Medicare may choose. These plans cover 50% to 100% of out-of-pocket costs, including those related to skin cancer.
Medicare Advantage
Medicare Advantage is an alternative to Original Medicare and provides all of the coverage of parts A and B.
Many Medicare Advantage plans also offer prescription drug coverage, which would include chemotherapy drugs for skin cancer.
Original Medicare, Medicare Advantage plans, and PDPs all have out-of-pocket costs. The sections below will look at these costs in more detail.
Original Medicare
Part A out-of-pocket costs include:
- a $1,676 deductible for each benefit period
- a $0 copayment for days 1 to 60 of each benefit period
- a $419 copayment per day for days 61 to 90 of each benefit period
- a $838 copayment per day for each lifetime reserve day of each benefit period
Part B out-of-pocket costs include a $257 deductible and a 20% coinsurance of the Medicare-approved expenses.
Medicare Advantage
The out-of-pocket costs for Medicare Advantage plans are deductibles, copayments, coinsurance, and monthly premiums. Because private insurance companies administer Medicare Advantage, all of these costs vary among plans, plan providers, and regions.
Part D
Out-of-pocket costs for Part D include deductibles, copayments, coinsurance, and monthly premiums.
Like Medicare Advantage plans, the costs of Part D may differ among plan providers, plan types, and regions, as private insurers administer these policies.
In skin cancer, malignant cells form in the skin — typically beginning in the outermost layer of the skin, called the epidermis. The cancer may then spread to deeper skin levels as well as other parts of the body.
Although the condition can occur anywhere, it most commonly affects the face, neck, and hands.
A cancerous mole, or melanoma, is less common than other forms of skin cancer and more likely to spread to surrounding tissue.
Some risk factors for skin cancer include:
- older age
- fairer skin
- a history of sunburn
- prolonged exposure to sunlight
- extensive use of tanning beds
However, even a person who has none of these risk factors may develop skin cancer.
To diagnose skin cancer, a doctor may order a biopsy of the skin lesion. If the biopsy indicates the presence of cancer, a person may have to undergo tests to determine whether or not it has spread.
These tests may include a CT scan, an X-ray, an ultrasound exam, or a lymph node biopsy.
After diagnosis, treatment may include the following:
- Surgery: A surgeon may use a variety of methods to remove or cut out a lesion.
- Chemotherapy: This refers to the use of drugs that aim to stop cancer cell growth.
- Photodynamic therapy: This refers to the application of a drug followed by exposure to a certain kind of light source that destroys cancer and precancerous cells.
- Radiation therapy: This refers to the use of beams of high energy X-rays to kill cancer cells.
- Immunotherapy: This refers to the use of a person’s own immune system to fight cancer.
- Chemical peel: This refers to the application of a chemical solution to the skin to dissolve the top layer of skin cells.
- Targeted therapy: This refers to the use of drugs and other agents to attack cancer cells.
- Other drug therapy: This refers to the use of other agents to fight cancer, such as diclofenac, which is a rheumatoid arthritis medication, and drugs related to vitamin A.
Actinic keratoses are precancerous lesions in the outer layer of skin related to sun exposure.
The patches may appear scaly and rough, and the color may vary. Most of these lesions do not cause any symptoms, but some may lead to itching or tenderness.
Because some actinic keratoses turn into skin cancer, Medicare covers their surgical removal. It also covers a range of treatment methods, including:
- cryosurgery, which is the application of liquid nitrogen to destroy the lesions
- topical chemotherapy drugs
- curettage, which is a process that involves scraping away the lesions
- photodynamic therapy
Starting with the initial appearance of lesions or symptoms that may indicate skin cancer, Medicare covers diagnosis and treatment.
Both original Medicare and Medicare Advantage plans provide broad coverage.
Some people with skin cancer may require chemotherapy drugs that Part B does not cover. If so, it would be beneficial to have either a Part D plan that works alongside original Medicare or a Medicare Advantage plan that includes prescription drug coverage.