Medicare covers the prevention, diagnosis, and treatment of skin conditions but not cosmetic services or routine skincare exams
Does Medicare cover dermatology? | Dermatology coverage with Medicare | FAQs | Participating Medicare dermatologists | Costs | Other ways to save on dermatology
One in five Americans will develop skin cancer by the age of 70, according to the Skin Cancer Foundation. The risk of melanoma increases as people age. Even though Melanoma only accounts for about 1% of skin cancers, it causes a large portion of skin cancer deaths. The average age of people when melanoma is diagnosed is 65. From age 50 on, significantly more men develop melanoma than women.
Older adults are among the most at-risk groups for developing skin problems. Given the above statistics, it’s crucial that Medicare beneficiaries understand what’s covered regarding dermatology care. Does Medicare cover dermatology screening and visits? What else is or is not covered by Medicare?
Whether you’re seeking treatment of skin conditions or just need a routine skin checkup, this article will provide you with the information you need to make the most of your Medicare coverage.
Does Medicare cover dermatology?
Original Medicare coverage
Original Medicare (Medicare Part A and Part B) covers medically necessary dermatology services to prevent, diagnose, and treat skin disorders. However, the federal Medicare program doesn’t cover any services or treatments considered cosmetic. Original Medicare does not typically require referrals from primary care doctors for specialists like dermatologists.
Medigap coverage
A Medicare supplement plan will pay for part of all of the costs remaining after Medicare has covered their portion. They were created to work alongside Parts A and B as a cost-sharing program to alleviate out-of-pocket costs for subscribers. If you get an outpatient laser surgery to remove a tumor, Part B will likely cover 80% of the medicare-approved amount. Your Medigap plan will pick up the remaining 20%.
Medicare Advantage coverage
Medicare Advantage plans (Part C) must cover the same services as Original Medicare. However, it’s up to the private insurance company how much of that service they will pay for. This means, your out-of-pocket costs won’t be the same as they would be if you had Original Medicare.
Unlike Original Medicare, many Medicare Advantage plans will require a referral to make a dermatology appointment and will require utilizing the plan’s network of providers. They may have higher out-of-pocket costs for dermatology services and treatments than compared to Original Medicare.
Medicare Part D coverage
A Medicare Part D prescription drug coverage plan may cover the prescription medications prescribed by your dermatologist. Enrollment in a Part D plan is not automatic and must be selected by the beneficiary. The costs of Part D will vary depending on the medications prescribed.
What does Medicare cover for dermatology?
If considered medically necessary, Medicare will cover the following dermatology procedures:
- Removal of a skin lesion
- Laser surgery
- Biopsy
- Skin graft
- Mohs surgery
- Cryotherapy
There are situations where cosmetic procedures may be considered both cosmetic and medically necessary. In this case, you’ll receive coverage under Medicare. Some examples include:
- Eyelid surgery to correct impaired vision
- Botox injection for chronic migraines
- Varicose vein surgery to improve circulation
- Rhinoplasty to correct any breathing problems
- Removal of excess skin to prevent skin ulcers
What’s not covered?
- Facelift
- Laser hair removal
- Liposuction
- Tummy tuck
If your service or treatment has been denied by Medicare, and you feel that it should’ve been covered, you can file an appeal.
Medicare dermatology coverage FAQs
Does Medicare cover skin removal surgery?
Yes, if you have excess skin, and your healthcare provider says it’s medically necessary, Medicare Part B will cover outpatient skin removal surgery. There are some requirements to meet before the surgery can be approved:
- Excess skin impacts your daily life
- The medical condition threatens your skin health
Does Medicare cover skin removal after gastric bypass surgery?
Yes, Medicare will cover skin removal after gastric bypass surgery if your BMI is down at least five points, and your weight is stable for at least six months before the skincare removal surgery. Coverage will fall under Medicare Part B.
Does Medicare cover skin cancer screening?
Yes, if your healthcare provider deems it medically necessary, Medicare will cover your screening for skin cancer. Coverage will fall under Medicare Part B.
RELATED: Melanoma treatments and medications
Does Medicare cover skin tag removal?
Medicare will only cover skin tag removal if your healthcare provider deems it’s medically necessary. Coverage will fall under Medicare Part B.
Does Medicare cover a full-body skin exam?
No, Medicare does not cover full-body skin exams that are considered routine.
Does Medicare cover skin cancer removal?
Yes, Medicare Part B will cover 80% of the cost of your outpatient skin cancer removal procedure.
Does Medicare cover hair loss treatment?
Unless your healthcare provider deems the treatment for your hair loss medically necessary, Medicare will not cover hair loss treatment.
Does Medicare cover laser hair removal?
No, Medicare does not cover dermatological services that are considered cosmetic. Laser hair removal is considered a cosmetic treatment.
Does Medicare cover hair transplants?
No, since Medicare does not typically cover treatment for hair loss, the program won’t cover a hair transplant.
Does Medicare cover acne treatment?
Under specific circ*mstances, Medicare may cover acne treatment if your healthcare provider deems it medically necessary due to the acne being a symptom of a medical problem. If you’re prescribed acne medication, coverage would fall under Medicare Part D.
RELATED: What causes adult acne?
Does Medicare cover rosacea treatment?
Yes, if the treatment for your rosacea is approved by the FDA, Medicare will cover it. Any treatment at an outpatient facility will fall under Medicare Part B. Any medications prescribed will be covered under Medicare Part D.
RELATED: Psoriasis vs eczema
Does Medicare cover dermatology visits?
No, Medicare does not cover routine doctor visits to the dermatologist. Medicare will cover a visit if there is a skin problem in need of Medicare covered treatment.
Do I need a referral to see a dermatologist with Medicare?
In most cases, you will not need a referral to see a dermatologist if you have Original Medicare. However, if you have a Medicare Advantage plan, you’ll most likely need a referral.
Finding dermatologists that accept Medicare
The Centers for Medicare & Medicaid Services (CMS) make it easy to find dermatologists that participate in Medicare. The new tool on medicare.gov, Care Compare, gives you access to all hospitals and doctors who accept Medicare.
All you have to do is type in your zip code, the provider type, and any additional keywords to help find the right primary care physician for you.
How much do dermatology treatments cost with Medicare?
Any dermatological treatments received at an outpatient facility will have 80% coverage under Medicare Part B for the Medicare-approved amount. You’ll be responsible for the remaining 20% coinsurance as well as the Part B deductible, which is currently $226.
If you have Medicare supplement insurance, the 20% coinsurance will likely be covered. Depending on what letter plan you have, the Part B deductible may also be covered. If you have Medigap Plan F, you’ll have zero out-of-pocket costs.
If you have a Medicare Advantage plan, it will depend on your specific plan regarding how much your out-of-pocket costs will be. It’s very difficult to predict what these out-of-pocket costs will be since each healthcare provider bills differently and every Medicare Advantage plan has its own coverage guidelines.
If you’re prescribed any medications by your healthcare provider, your Medicare Part D or Medicare Advantage prescription drug plan will cover them if they are included on your plan’s formulary. How much you pay out of pocket for your medication depends on how your plan’s drug formulary ranks them.
RELATED: What is a Medicare formulary?
Other ways to save on dermatology
1. SingleCare coupons
Free prescription coupons are available through SingleCare. These coupons can save you money (up to 80%), even if you currently have Medicare or another type of health insurance.
You may be able to save more money on your prescriptions by using SingleCare instead of your Medicare insurance plan. However, any money spent with SingleCare instead of Medicare will not apply to your Medicare deductible.
2. Medicare Extra Help
If you meet the low-income requirements or are dual-eligible for both Medicare and Medicaid, then you can get help paying for medications prescribed by your dermatologist or healthcare provider. The Medicare Extra Help program will reduce your out-of-pocket costs for prescription drugs.
3. Medicaid
Medicaid is a health insurance program for low-income people of any age. Medicaid may cover or subsidize goods and services at a higher rate than Medicare. Medicaid eligibility and coverage is determined by the state.
RELATED: Medicare vs. Medicaid
4. Free samples at your doctor’s office
When prescribed a new medication, free samples may be available at the healthcare provider’s office. A small, free sample gives the patient an opportunity to try the medication to make sure it works before filling a prescription. However, this is not a long-term solution to save money on your prescriptions.
5. Manufacturer coupons and patient assistance programs
Drug coupons may also be available through the manufacturer, especially for brand-name medications. Contact the drug manufacturer to find out if you qualify. However, these manufacturer coupons often exclude Medicare consumers. Patient assistance programs may also be available through nonprofit organizations.
