Does Medicare Cover Dermatology?
Key Takeaways
- Typically, Original Medicare (Part A and Part B)Original Medicare is a fee-for-service health insurance program available to Americans aged 65 and older and some individuals with disabilities. Original Medicare is provided by the federal government and is made up of two parts: Part A (hospital insurance) and Part B (medical insurance). will not cover routine or elective dermatology services.
- Original Medicare doesn’t cover an annual skin check, but it will cover an evaluation or testing if medically necessary.
- If you’re diagnosed with skin cancer, Medicare will cover your treatments.
It’s important to care for your skin by limiting the time you spend in the sun, wearing sunscreen and protective clothing skin outside, and seeing a dermatologist when you have concerns. Cosmetic and preventive dermatology services typically are not covered by Original Medicare, but medically necessary services usually are.
Medicare Advantage plans from private insurance carriers must offer at least the same coverage as Original Medicare. Plans may include additional benefits.
Learn about your dermatology coverage to make sure you catch any serious conditions early.
Find the Medicare Advantage plan that meets your needs.
What Dermatology Procedures are Covered by Medicare?
Skin cancer is the most common form of cancer in the United States. If you have been diagnosed with skin cancer, Original Medicare (Parts A and B) or Medicare Advantage (Part C) will cover treatments.
Part A — which is hospital insurance — will cover any inpatient surgeries or treatments related to skin cancer. Part B — which is medical insurance — covers the outpatient surgeries and other treatments that are most commonly used to treat skin cancer.
A Medicare Advantage plan substitutes for Original Medicare and provides at minimum the same coverage as Parts A and B. Some plans may offer additional coverage.
Does Medicare cover dermatology skin check?
Original Medicare doesn’t cover an annual skin check, but it will cover testing if your doctor discovers a potential symptom, like a skin spot or more, that needs further evaluation.
Medicare does not cover screening for skin cancer in asymptomatic people. It does, however, cover a physician visit if you’re concerned about, for example, a change in the color of a mole or a new skin growth.
If you’re looking for a dermatologist who accepts Medicare, Medicare.gov provides a search tool.
Generally, Medicaid, which is a separate health insurance program for people with limited incomes, covers dermatology much like Medicare does. Each state administers its own Medicaid program, so check for coverage details in your area.
Does Medicare Require a Referral to See a Dermatologist?
If you have Original Medicare, you don’t need a referral to see a dermatologist who takes Medicare for medically necessary services.
On a Medicare Advantage plan, you will get the fullest coverage by seeing healthcare providers who are in your network. Depending on the terms of your specific plan, you may need a referral from your primary care provider to see a specialist. Check your plan details before making an appointment.
How Will Medicare Pay for a Dermatologist?
Medicare pays for an approved dermatological procedure the same as other services.
If Part B covers the service, Medicare will pay 80% of the cost after you meet your annual deductible. In the less common scenario where you need inpatient care, covered by Part A, Medicare won’t charge coinsurance for up to 60 days as an inpatient after you meet the Part A deductible for the benefit period.
When you receive drugs in an outpatient setting, such as a doctor’s office, they are covered by Medicare Part B. However, if you are prescribed medications to take at home, you will need a Medicare Part D prescription drug plan to help with those costs. Medicare Advantage Prescription Drug plans include Part D coverage.
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Does Medicare Advantage Cover Dermatology?
Medicare Advantage plans will at least cover any dermatology services that would be covered by Original Medicare. Coverage details and costs differ by plan, and plan availability depends on what ZIP code you live in. Check the specifics for your particular plan.
Sources
- Melanoma of the Skin Statistics. CDC.gov.
- Medicare Coverage of Cancer Treatment Services. Medicare.gov.
- Screening for Skin Cancer. NIH.gov.
- Find & compare nursing homes, hospitals & other providers near you. Medicare.gov.