Does Medicare Cover Dermatology? Yes, But!
You see, 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 straight forward. For Medicare to cover a dermatology service, the skin condition should be deemed medically necessary to examine, diagnose, and to be corrected.
Only certain kind of infections, injuries, illnesses, or symptoms covered by Medicare.
Medicare will not cover cosmetic dermatology services (appearance improvement) or services that are routine in nature (whole-body exam).
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 straight forward answer whether Medicare covers dermatology or not.
So if you’re enrolled under Medicare and want dermatology services, you need to know if Medicare will cover your treatment.
Read on to find out which dermatology services are covered by Medicare and how you can find a dermatologist that accepts Medicare.
Which Dermatology Services and Conditions Does Medicare Cover?
Some Medicare Part D plans may cover the cost of preventive screenings. If you’re not sure about coverage, you can contact your Medicare Advantage Plan provider to determine if preventive screenings are covered.
Coverage for meds to correct dermatological conditions depends on your Medicare Plan. If you have an Advantage Plan, it will cover the cost of your prescription meds.
However, remember that only private insurance companies offer Medicare Part C and D.
Each Advantage Plan has a formulated list of meds that it covers, and they are 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.
If your physician deems it, necessary Medicare Part B will pay for a skin biopsy to check for cancerous tissue. If any 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 the skin tag removal is deemed medically necessary by a physician, Medicare will cover it. Medicare will also pay for seborrheic keratosis and wart removal if they are constantly bleeding or causing you discomfort.
Part B will pay for Psoriasis exams and also any Meds and treatments provided by a dermatologist. 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 because they will treat a specific infection, injury, or disease.
Medicare will also cover skin examinations done 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 hence why Medicare won’t cover them.
Medicare won’t cover prescription meds for cosmetic purposes such as hair growth or other purposes considered cosmetic in nature.
Which Parts of Medicare Cover Dermatology?
Medicare Part A
Medicare Part A does not cover routine dermatology services or even procedures deemed to be 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 and D) is another way for people to access the benefits found in Part A and B. Medicare Part C can cover additional dermatology services such as prescription meds and routine exams.
Your Part C provider will give you with all the details. You can also check the papers you got 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.
- Provider (pick physician).
- Specialty (pick dermatology).
After entering these details click on search, and you’ll be able 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 you want 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 A and B, you don’t need a referral to see a dermatologist or any expert physician enrolled under Medicaid.
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?
Dermatology services are vital as a person ages; you need to have insurance to correct these conditions if they arise. For this reason, Medicare covers costs of skin cancer and other serious skin conditions such as psoriasis, rosacea, and eczema.
To access dermatology services, contact your local agency to get a physician that accepts Medicare.
Dermatology Clinical Trials are also available throughout the United States.