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, does Medicaid cover dermatology?
In Medicaid, all types of coverage mainly depend on the US State you reside in, and this is the case as well with dermatology.
So, your State determines what will and will not be paid for concerning the dermatology services you receive.
Medicaid is a state-by-state program, and therefore its governed mainly by state laws rather than federal laws.
More than ever, States are beginning to see the importance of including dermatology services in Medicaid because skin problems are on the rise.
What is Dermatology?
Dermatology is the study, diagnosis, and treatment of any health conditions that pertain to the skin and hair.
The skin is the largest organ in the body, and it assumes the role of protecting internal organs from bacteria and injury.
Therefore, the skin is exposed to various toxic substances, and if not taken care of, they can be detrimental.
In addition, the skin acts as an indicator of the general well-being of the body. This makes 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 their life.
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 will have to pay out-of-pocket.
In some states, you may be charged an out-of-network fee or even end up paying 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 get you the referral verification you need to see a specialist.
Which Dermatologic Conditions are Covered by Medicaid?
If your state of residence allows Medicaid to cover your dermatology services, some of the conditions you can get include treatment:
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 as well as skin cancer care.
Port Wine Stain Removal
Port-wine stain removal is a laser operation to remove severe birthmarks that look like wine stains.
This treatment has become a mandatory benefit in some States, such as Minnesota. And this means that Medicaid is obligated to cover this treatment in all other states.
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 and ointments alongside other treatments can help relieve the pain.
So if you develop this condition, Medicaid will cover dermatology expenses. However, you will still have to pay your deductibles and make any necessary copayments.
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.
Kids are covered under the CHIP (Children’s Health Insurance Program) for eczema, and adults are covered by Medicaid.
Medicaid won’t pay for treating some conditions such as Acne and Keloids since they are considered cosmetic.
Actual cosmetic procedures such as chemical peels, tattoo removals, and Botox are deemed elective and therefore not covered by Medicaid as well.
How Can You Find a Dermatologist That Accepts Medicaid Cover?
To locate a dermatologist near you that accepts Medicaid coverage, you can use Medicaid’s physician compare tool.
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 show up 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 when compared to persons with private insurance. So why is this the case?
For starters, Medicaid only pays for about 60% of reimbursement costs.
Reimbursement should cater for the cost of providing medical support staff, rent for medical premises, and utilities. This doesn’t even include the payment for the doctor’s time and work.
Dermatologists often bring their medical supplies when they are called in-hospital consultations. The necessary equipment for procedures like skin biopsies can be hard to find in medical centers.
For instance, in Ohio, Medicaid’s compensation for skin biopsy is 47.2 USD.
Still, the equipment and supplies to perform a biopsy exceed 50 USD, which means Medicaid pays less than the cost of supplies and equipment.
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.
To sum it all up, getting Medicaid to pay for your dermatology services principally depends on your state of residence.
Therefore, ensure you confirm with your local Medicaid provider to see if dermatology services are included in your plan.