Medicare covers dermatological services but only those that are medically necessary. The different parts of Medicare are designed to cover different aspects of patient care but almost all of them will kick in to help a patient navigate dermatological care.
Does Medicare Cover Dermatology?
In general, Medicare will cover exams to treat or diagnose a specific symptom, illness, injury, or complaint. They’ll also cover procedures and screenings to make sure the skin remains healthy.
For example, Medicare covers percutaneous tests for allergies, which involve puncturing, pricking, or scratching the skin. Additionally, as long as it’s medically necessary, Medicare will cover skin tag removal, and reimburse for wart removal.
Some skin cancer screenings are available with Medicare as well as outpatient checkups and procedures to remove cancerous moles and skin lesions. Medicare also covers psoriasis, including medications taken orally or by infusion.
What Medicare Parts Cover Dermatological Services?
The following Medicare plans will only cover medically necessary procedures and outpatient checkups. These specific parts of Medicare cover the following services:
Medicare Part B
Medicare Part B handles a majority of a patient’s medical and dermatological services. Typically, a patient won’t be able to see a specialist without a referral from their primary care physician. Whether a referral is required for Medicare to share the costs will depend on a patient’s plan.
Under HMO plans, a patient would have to get a referral from their primary care physician and would have to stay within the network for Medicare to pay. Under PPO plans, a referral isn’t necessary and although patients can use either an in-network or an out-of-network doctor, their overall costs will be lower for using an in-network care provider.
Medicare Advantage/Part C
The Medicare Advantage Plan is required to cover the same services that the traditional Medicare plans cover, but because of the way the cost-sharing is broken down, patients under this Medicare plan may wind up paying more out of pocket in copays and coinsurance. A best practice is to check with each provider to see which services are covered under this plan.
Medicare Part D
This part of Medicare is also known as a prescription drug plan and will help cover medications prescribed by a physician to treat a medically necessary ailment to keep the patient healthy. This plan is optional and is sold by private insurance companies.
Medigap is a Medicare supplement insurance plan that picks up the costs of some out-of-pocket expenses. These expenses can include deductibles, copays, coinsurance, and other expenses. This plan is available for purchase from private insurance companies and is specifically for those patients enrolled in Medicare Parts A & B and patients that are 65 years old and older or those with a disability.
What Dermatological Services Does Medicare Not Cover?
In general, Medicare doesn’t cover cosmetic procedures or procedures that aren’t medically necessary. This includes:
- Botox and wrinkle removal
- Laser hair removal
- Screenings for asymptomatic conditions
- Medications for hair growth
- Routine full-body scans
- Tummy tuck
While Medicare doesn’t cover cosmetic procedures, they will cover procedures that seem cosmetic in nature but are in fact medically necessary.
For example, they’ll cover a nose job as long as it’s to improve a patient’s breathing. They’ll cover botox injections if they’re going to correct muscle twitches or spasms. They’ll treat varicose veins to minimize inflammation and pain and improve circulation. They’ll also cover eyelid surgery to remove fatty tissue and improve a patient’s vision.
Finding a Dermatologist Who Accepts Medicare
Patients who would like to see a dermatologist for covered skin issues can start by typing in their city, state, and the word “dermatologist” in an online database called physician compare on the Medicare website.
Make sure to get a referral from a primary care physician if necessary for the patient’s plan and double-check with the selected dermatologist to make sure that they accept Medicare before any services are rendered.