Does Medicare Cover Dermatology?

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.

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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

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 medications it covers, grouped in ranks. Lower-ranked medications will cost less than higher-ranked medications.

You can speak to your doctor and ask them to prescribe a generic version of a cheaper drug 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. Medicare will pay for the treatment if cancerous tissue is found, but you’ll still be liable for the deductibles and coinsurance.

Skin Tag Removal

Medicare will cover if a physician deems skin tag removal medically necessary. Medicare covers removal of seborrheic keratoses and warts only when they meet specific medical necessity criteria.

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 covers medically necessary treatments for rosacea, but not all FDA-approved treatments are automatically covered by Medicare.

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 covers inpatient hospital care for dermatological conditions requiring hospitalization, but outpatient dermatology services are covered under Part B.

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) plans must cover all services that Original Medicare covers, often including prescription drug coverage (Part D benefits). 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.

Check if your plan covers the treatment your dermatologist recommends to avoid unforeseen costs.

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. The Medicare Part B deductible for 2023 is $226, 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 Provider 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 that once you visit the doctor, you won’t be charged more than what Medicare recommends, and 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.

With Original Medicare (Parts A and B), you can see any specialist who accepts Medicare without a referral, but some Medicare Advantage plans require referrals; 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.

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.

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