Does Medicaid Cover Dermatology?

Does Medicaid Cover Dermatology – Overview

The issue of Medicaid’s dermatology coverage extent confuses people looking for a means to visit a dermatologist.

So you’ve got a skin condition only to find the procedure costs are very high, and you might be wondering if Medicaid covers dermatology.

In Medicaid, all types of coverage mainly depend on the US State you reside in, and this is also the case with dermatology.

So, your State determines what will and will not be paid for concerning the dermatology services you receive.

Medicaid is a joint federal-state program governed by federal mandates alongside state regulations.

Including dermatology services in Medicaid coverage, which varies by state and is subject to state discretion and medical necessity.

What is Dermatology?

Dermatology is the study, diagnosis, and treatment of health conditions affecting the skin and hair.

The skin is the largest organ in the body, and it protects internal organs from bacteria and injury.

Therefore, the skin is exposed to various toxic substances, which can be detrimental if not taken care of.

In addition, the skin indicates the general well-being of the body, making dermatology services vital in diagnosing and treating numerous illnesses.

Issues with the skin and hair follicles are prevalent, and almost everyone contracts a dermatologic condition at some point.

In fact, around one in six physician appointments pertain to skin problems.

How Can You See a Dermatologist With Medicaid Cover

Medicaid deems it necessary for you to get a referral from your primary care doctor to see a dermatologist.

If you wish to pay for dermatology services, out-of-pocket referrals aren’t necessary, and you can head straight to the dermatologist and book an appointment.

A referral is a written order from your primary care physician that states that you need to see a specialist and, in this case, a dermatologist.

Referrals are a strategy that Medicaid uses to cut costs by verifying there’s a legitimate need for you to visit a specialist.

Without a referral, Medicaid won’t settle your dermatologic expenses, and you must pay out-of-pocket.

In some states, you may be charged an out-of-network fee or even pay for the entire visit if the dermatologist you visit is not under the Medicaid network.

You don’t always have to book an appointment to get a referral from your primary care physician.

Sometimes, a simple phone call will be sufficient to obtain the referral verification you need to see a specialist.

Does Medicaid Cover Dermatology? What are the Dermatologic Conditions Covered by Medicaid

If your state of residence allows Medicaid to cover your dermatology services, some of the conditions you can get include treatment:

1. Skin Cancer

Skin cancer is a condition whereby abnormal growth of skin cells is mainly caused by skin exposure to direct sunlight. Skin cancer is by far the most widespread form of cancer.

There are three main types of skin cancer: melanoma, squamous cell carcinoma, and basal cell carcinoma.

Medicaid’s recent expansions have reduced the cost barriers for skin cancer screenings and care.

2. Port Wine Stain Removal

Port-wine stain removal is a laser operation to remove severe birthmarks that look like wine stains.

While Medicaid might cover port-wine stain removal in some states like Minnesota due to state-specific mandates.

3. Psoriasis

Psoriasis is a skin condition that causes red and inflamed crusty patches, which commonly appear on the scalp, elbows, knees, and trunk.

There is no definite remedy for psoriasis, but moisturizers, ointments, and other treatments can help relieve the pain.

So if you develop this condition, Medicaid will cover dermatology expenses. However, you must still pay your deductibles and make any necessary copayments.

4. Eczema

Eczema, also known as atopic dermatitis, is a condition that makes your skin sore and itchy. It’s pretty common in children, but it can also manifest at any age.

While CHIP covers children for various conditions, including eczema, Medicaid coverage for adults for the same condition can vary by state.

Medicaid generally does not cover cosmetic treatments, such as acne or keloids, unless these conditions lead to severe complications or are part of a broader medically necessary procedure.

Medicaid does not cover purely cosmetic and elective procedures, such as chemical peels, tattoo removals, and cosmetic Botox applications.

How Can You Find a Dermatologist That Accepts Medicaid Cover?

To find a dermatologist who accepts Medicaid, you can use resources provided by your state’s Medicaid program or contact dermatologists directly to inquire about Medicaid acceptance.

To use this tool, open Medicaid’s portal, type in your State and City, and use the keyword “dermatology.”

Dermatologists and skincare clinics within a 15-mile radius should appear in the search results.

This online tool is ideal because it can also display the physician’s performance data, such as patient ratings.

Why Do Dermatologists Reject Medicaid Cover?

It’s a well-known fact that it’s more difficult for a Medicaid enrollee to get a dermatologist appointment than for persons with private insurance. So why is this the case?

Medicaid reimbursement rates to healthcare providers can be significantly lower than those from private insurance, often covering less than the actual cost of services.

Reimbursement should cover the cost of providing medical support staff, renting medical premises, and utilities. This doesn’t even include the doctor’s time and work payment.

Dermatologists often bring their medical supplies when they are called for in-hospital consultations. While the cost of equipment for procedures like skin biopsies can be a concern, the availability of such equipment in medical centers is typically standard.

Medicaid reimbursement rates for specific procedures, such as skin biopsies, vary by state and may not fully cover the cost of the procedure and associated supplies.

So, in such a scenario, the physician provides their time and services for free. However, they lose money on every appointment that involves a skin biopsy.

Final Thought

To sum it up, getting Medicaid to pay for your dermatology services depends on your state of residence.

Therefore, confirm with your local Medicaid provider to see if dermatology services are included in your plan.

See Also

Does Medicaid Cover Chiropractic

Dermatology Clinical Trials

Best Dermatology Schools

Cosmetic Surgery Grants

How to Become a Dermatologist

Does Medicare Cover Long Term Care

Current Version
August 9, 2023
Updated By
Andrea Morales G.
April 14, 2024
Updated By
Andrea Morales G.

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