Medicare Dermatology Coverage
Your skin is your first line of defense against infections and injuries. As a result, skin disorders are common and can vary from insignificant to severe, and at times, you might need to see a specialist.
Yes, Medicare covers dermatology but it’s not that straightforward. For Medicare to cover a dermatology service, the skin condition should be deemed medically necessary to examine, diagnose, and correct.
Only certain kinds of infections, injuries, illnesses, or symptoms are covered by Medicare.
Medicare will not cover cosmetic dermatology services (appearance improvement) or routine services (whole-body exams).
A cosmetic procedure can only be covered if it enhances the function of a deformed body part or corrects an accidental injury. As we said, there is no straightforward answer to whether Medicare covers dermatology.
So, if you’re enrolled under Medicare and want dermatology services, you need to know if Medicare will cover your treatment.
Read on to learn which dermatology services are covered by Medicare and how to find a dermatologist who accepts Medicare.
Which Dermatology Services and Conditions Does Medicare Cover?
Preventive Screenings
Medicare Part D plans do not cover preventive screenings; these plans only cover prescription drugs. If you’re unsure about coverage, contact your Medicare Advantage Plan provider to determine if preventive screenings are covered.
Medication
Your Medicare plan may cover prescription medications to correct dermatological conditions. Medicare Advantage Plans (Part C) may also cover prescription medications.
Private insurance companies administer Medicare Part C and Part D plans, but these are still part of the Medicare program the government offers.
Each Advantage Plan has a formulated list of meds that it covers and is grouped in ranks. Lower-ranked meds will cost less than higher-ranked meds.
So you can speak to your doctor and ask them to prescribe a generic version of a drug that will be cheaper or an alternative that’s included in the list formulated by your Medicare Part D provider.
Skin Cancer
If your physician deems it necessary, Medicare Part B will pay for a skin biopsy to check for cancerous tissue. If cancerous tissue is found, Medicare will pay for the treatment, but you’ll still be liable for the deductibles and coinsurance.
Skin Tag Removal
If a physician deems skin tag removal medically necessary, Medicare will cover it. Medicare will also pay for seborrheic keratosis and wart removal if they are constantly bleeding or causing discomfort.
Psoriasis
Medicare Part B covers dermatology services for psoriasis if deemed medically necessary; however, it generally does not cover medications, which could be covered under Part D. Medicare will also cover any rosacea treatment sanctioned by the FDA.
Which Dermatology Services Will Medicare Not Cover
Full-Body Skin Exam
Medicare doesn’t cover full-body skin checkups. Medicare only covers exams approved to treat a specific infection, injury, or disease.
Medicare will also cover skin examinations after a biopsy because this isn’t routine.
Laser Hair Removal
Medicare won’t cover cosmetic dermatology procedures such as laser hair removal. This procedure is not necessary to diagnose or treat an illness or injury.
In addition, cosmetic procedures enhance one’s appearance, so Medicare won’t cover them.
Prescription Meds
Medicare won’t cover prescription meds for cosmetic purposes such as hair growth or other purposes considered cosmetic.
Which Parts of Medicare Cover Dermatology?
Medicare Part A
Medicare Part A does not cover routine dermatology services or procedures deemed medically necessary by a physician.
Medicare Part B
Dermatology services are covered by Part B if it’s proven that the service is Medically necessary to examine.
For instance, to diagnose or treat a certain medical condition. However, depending on the procedure or service, you may still need to pay a deductible.
Medicare Part C
Medicare Advantage (Part C) combines the benefits of Medicare Part A and Part B, and sometimes Part D, but Part C and D are not the same and offer different types of coverage. Medicare Part C may cover additional services like prescription meds and potentially more routine exams.
Your Part C provider will provide you with all the details. You can also check the papers you received when you enrolled to see if you need a referral from a primary physician to see a dermatologist.
To avoid unforeseen costs, ensure you check if your plan covers the treatment recommended by your dermatologist.
Also, note that Medicare Part C plans sometimes charge different copays for specialist doctors and primary care doctors.
What Are the Out-Of-Pocket Costs for Dermatology?
If Part B covers your medically necessary dermatology services, you will still be liable to pay some out-of-pocket expenses. These expenses include the deductible ($203 in 2021), the coinsurance, which is 20% of the cost of your treatment.
You should only pay your coinsurance after you’ve paid off your deductible.
Ensure you check with your dermatologist and primary care doctor before treatment starts so that you find out if dermatology services are covered and how much you need to pay.
How Can You Find a Dermatologist That Accepts Medicare?
If you have Medicare Part A and B, use the Provide Finder tool on the official Medicare portal. You’ll be prompted to enter:
- Your location.
- The provider (pick physician).
- Specialty (pick dermatology).
After entering these details, click on search to see a list of dermatologists in your area. Along with the location and contact details, each physician should indicate whether or not their prices are the same as the approved amounts for these services.
This means once you visit the doctor, you won’t be charged more than what Medicare recommends, and as a result, your out-of-pocket costs will be as low as possible.
Once you decide which dermatologist to visit, contact their premises to verify the location. Also, confirm if they are taking in new Medicare recipients and if you need a referral from your primary care physician.
If you have Medicare Part B, you generally do not need a referral to see a dermatologist; however, some Medicare Advantage Plans might require a referral.
However, when you visit your primary care GP, they can also recommend a dermatologist if they feel you need to see one.
See Also Does Medicaid Cover Dermatology
Final Thought
Dermatology services are vital as people age; insurance is needed to correct these conditions if they arise. For this reason, Medicare covers the costs of skin cancer and other serious skin conditions such as psoriasis, rosacea, and eczema.
Contact your local agency to get a physician who accepts Medicare to access dermatology services.
Dermatology Clinical Trials are also available throughout the United States.
See Also
Does Medicare Cover Cataract Surgery?
Does Medicare Cover Hearing Aids?
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