Medicare covers inpatient and outpatient care for skin cancer. People with original Medicare parts A and B or Medicare Advantage plans can expect extensive coverage, but they will likely have out-of-pocket costs to pay.
Early detection and treatment of skin cancer are 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.
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.
If a person does not have any symptoms of skin cancer, Medicare does not cover screening. However, if someone notices a new skin growth or a change in the appearance of a mole, Medicare will cover a visit to the doctor.
Should a doctor notice 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 cover these visits, as well.
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.
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 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.
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.
Part A out-of-pocket costs include:
- a $1,408 deductible for each benefit period
- a $0 copayment for days 1–60 of each benefit period
- a $352 copayment per day for days 61–90 of each benefit period
- a $704 copayment per day for each lifetime reserve day of each benefit period
Part B out-of-pocket costs include a $198 deductible and a 20% coinsurance of the Medicare-approved expenses.
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.
Out-of-pocket costs for Part D include deductibles, copayments, coinsurance, and monthly premiums.
Like those of Medicare Advantage plans, the costs of Part D may differ among plan providers, plan types, and regions, as private insurers administer these policies.
The skin is the largest organ in the human body. In skin cancer, malignant cells form there.
Although the condition can occur anywhere, it most commonly affects the face, neck, and hands.
Skin cancer begins in the outermost layer of the skin, called the epidermis. It may then spread to deeper skin levels as well as other parts of the body.
A cancerous mole, or melanoma, is less common than other forms of skin cancer and is 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.
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.