Yes, Original Medicare covers dermatology services that are a medical necessity, such as the diagnosis and treatment of skin conditions, including skin cancer. Medicare covers services to diagnose or treat a condition or disease.
Medicare covers dermatology services such as office visits, biopsies, and surgical procedures, for example, to treat skin cancer.
However, Medicare does not cover cosmetic services such as Botox injections or cosmetic surgery that are not deemed a medical necessity.
Depending on the dermatology service or procedure, you may be responsible for paying a deductible and a percentage of the Medicare-approved amount.
For instance, a routine full-body skin exam isn’t covered by Medicare. But Medicare covers an exam if it’s directly related to the diagnosis or treatment of a specific illness or injury. Normally, Medicare will pay for a skin exam following a biopsy indicating skin cancer.
When Should I See a Dermatologist?
Medicare patients should consider making a dermatology appointment if they have any of the following concerns:
Persistent or severe acne
Suspicious moles or growths on your skin
Skin rashes that don’t respond to over-the-counter treatments
Itchy or painful skin conditions
Chronic or severe dry skin
Hair loss or thinning
Skin infections, such as cellulitis or impetigo
Any other concerns related to your skin, hair, or nails that are affecting your quality of life or causing discomfort.
Will Medicare cover dermatology exams?
It’s also a good idea to see a dermatologist for an annual skin check (skin cancer screenings) if you have a family history of skin cancer or if you spend a lot of time in the sun.
Which Dermatology Procedures Are Covered by Medicare?
How does Medicare cover dermatology?
Medicare Part B (medical insurance) covers diagnostic and treatment services for skin conditions that are medically necessary.
This may include a wide range of dermatology procedures and medically necessary dermatology services, for example:
Skin cancer screening and biopsies
Excision or removal of skin lesions or potentially cancerous skin growth, including skin cancer
Acne treatment, eczema, psoriasis, and other skin conditions
Treatment for skin infections, such as cellulitis or impetigo
Cryotherapy, which uses extreme cold to remove skin growths
Mohs surgery, a specialized surgical technique for removing skin cancer
Photodynamic therapy (PDT), a treatment for certain types of skin cancer that uses light and a special medication
Skin allergy testing and treatment
Narrowband UVB phototherapy, a treatment for certain skin conditions, such as psoriasis and vitiligo
Chemical peels for certain medical conditions, such as actinic keratosis or acne scarring
Removal of excess skin to prevent skin ulcers or new skin growth
Eyelid surgery to correct impaired vision
Botox injection for chronic migraines
Varicose vein surgery to improve circulation
Rhinoplasty to correct any breathing problems
Hair loss treatment (for example, due to a medical condition such as alopecia areata or chemotherapy-induced hair loss)
There may be more dermatology procedures that Medicare covers, depending on the patient.
Does Medicare Cover Dermatology for Cosmetics?
Keep in mind that generally, there’s no Medicare coverage for a cosmetic dermatology procedure, such as Botox injections or laser skin resurfacing, unless it’s medically necessary for the treatment of a specific condition.
Medicare doesn’t cover cosmetic surgery unless it’s required to improve the functionality of a malformed body part or to repair an injury. For example, Medicare covers breast reconstruction surgery following a mastectomy due to breast cancer. If you have a primary care doctor, they’ll usually have a list of dermatologists they recommend for dermatology care. Then you can find the one that accepts Medicare. It’s important to check that your dermatologist will accept Medicare assignment.
Are Routine Dermatology Screenings Covered by Medicare?
Medicare Part B (medical insurance) covers routine dermatology screenings for skin cancer once a year for people who are at high risk of developing skin cancer, such as those with a history of skin cancer, extensive sun exposure, or a family history of skin cancer. The screening may include full-body skin exams by a dermatologist or other healthcare professional.
If a suspicious lesion or skin growth is found during the screening, Medicare will cover the cost of a biopsy or other diagnostic tests to determine if it is cancerous or not. If the lesion is cancerous, Medicare will cover the cost of treatment.
Remember that there’s no Medicare coverage for routine dermatology screenings for people who are not at high risk of developing skin cancer. In these cases, the screening may be considered a preventive service and may not be Medicare approved.
Will I Need a Referral From My Primary Care Physician?
In general, you don’t need a referral from your primary care physician for dermatology services to be covered by Medicare. Medicare Part B covers dermatology services that are medically necessary, including visits to a dermatologist for diagnostic and treatment services for skin conditions.
But if you’re enrolled in a Medicare Advantage plan (Part C), the rules for referrals may be different. Some Advantage plans require a referral from a primary care doctor for specialist services, including dermatology.
Check in with your Medicare Advantage plan to understand their rules and requirements for referrals. Ask your insurance provider, does Medicare cover dermatology and what’s included? What are my out-of-pocket expenses?
Do Medicare Advantage Plans Cover Dermatology?
Advantage plans are offered by private insurance companies approved by Medicare, and they provide benefits in the same categories as Original Medicare (Part A and Part B).
Under Part C, dermatology services may be subject to different rules and requirements than under Original Medicare. For example, some Advantage plans may require a referral from a primary care physician for dermatology services, while others may not. Also, Medicare Advantage plans will likely have different out-of-pocket costs and coverage limits than Original Medicare.
Do Medigap Plans Cover Dermatology?
Yes, Medigap plans (also known as Medicare Supplement insurance plans) can help cover dermatology services that are covered by Medicare Part B. Medigap plans are offered by private insurance companies and are designed to help pay for some of the out-of-pocket costs associated with Original Medicare, such as deductibles, copayments, and coinsurance.
As long as Original Medicare (Part A and Part B) covers a procedure, the Medicare supplement plan must pay its portion of your bill.
Does Medicare Cover Laser Hair Removal?
No, Medicare does not cover laser hair removal for cosmetic purposes for Medicare beneficiaries. Medicare only covers medically necessary services. Cosmetic procedures are not considered medically necessary.
Does Medicare Cover Skin Tag Removal?
Skin tags are generally considered a cosmetic issue and are not covered by Medicare if they are being removed solely for cosmetic reasons. However, if the skin tag is causing medical symptoms such as bleeding or irritation, or if a doctor determines that it is medically necessary to remove it to treat skin disorders, then Medicare may cover the procedure.
If you have a Medicare Advantage plan, their health insurance rules may vary. The doctor must seek approval from the Medicare Advantage insurance company.
What Else Is Not Covered For Dermatology By Medicare?
If they are performed for cosmetic reasons only, such as facelift, liposuction, tummy tuck, etc, cosmetic procedures are not covered by Medicare unless they are medically necessary for the treatment of a specific condition.
Experimental or unproven treatments
Medicare does not cover experimental or unproven treatments, including certain types of laser therapy or photodynamic therapy. Those are not considered to be medically necessary treatments.
Services provided by non-physician providers, such as aestheticians or medical spas, are generally not covered by Medicare insurance.
Are Prescription Drugs For Skin Disorders Covered By Medicare?
Medicare covers some prescription medications that are used to treat skin conditions, but coverage may vary depending on the type of medication and the plan you have.
Medicare Part D (prescription drug coverage) covers a wide range of prescription medications, including those used to treat skin conditions such as acne, eczema, psoriasis, and skin infections. However, not all medications are covered by all Part D plans, and some may require prior authorization or step therapy.
Some medications may be covered under Medicare Part B (medical insurance) instead of Medicare Part D, depending on how they are administered. For example, medications that are administered in a doctor’s office or clinic, such as injectable biologics, may be covered under Part B.
Our mission is to help you make an informed decision on all things Medicare! Contact us today for a free, friendly consultation about Medicare. We will help you learn all about Medicare so you are confident in your decisions.