Does Medicare Cover Dermatologist Visits?
Understand Medicare's coverage for dermatologist visits, including covered services, exclusions, and your potential out-of-pocket costs.
Medicare is a federal health insurance program for individuals aged 65 or older, and for some younger people with certain disabilities. Beneficiaries often ask about coverage for dermatology services. Understanding Medicare’s application to skin care is important for managing health needs and financial responsibilities.
When Medicare Covers Dermatology Services
Medicare primarily covers dermatology services when they are medically necessary, meaning essential for diagnosing, treating, or managing a disease, injury, or medical condition. Most covered outpatient dermatology care falls under Medicare Part B, which helps pay for doctor visits, outpatient therapies, and other medical services. This includes dermatologist visits for conditions like skin cancers, eczema, or psoriasis.
Covered services include diagnosing and treating skin cancers, such as biopsies, excisions, and Mohs surgery. Medicare also covers treatments for chronic skin conditions like severe acne, eczema, psoriasis, requiring prescription medications, phototherapy, or steroid injections. Removal of skin lesions like moles or warts is covered if they are suspicious for cancer, causing symptoms like pain or bleeding, or are otherwise medically indicated. Referrals to dermatologists are covered when a primary care physician determines the need for specialized care due to a medical concern.
While Part B is the primary coverage for outpatient dermatology, Medicare Part A, hospital insurance, applies in limited situations. Part A covers inpatient hospital stays and dermatology-related treatments if a severe skin condition necessitates hospitalization. If extensive skin infections or complications from a dermatological condition require inpatient care, Part A helps cover those costs. Most routine or specialized dermatology services are handled through Part B.
When Medicare Does Not Cover Dermatology Services
Medicare does not cover dermatology services that are not medically necessary. This includes procedures for cosmetic reasons, to improve appearance rather than treat a medical condition. Examples of non-covered cosmetic procedures include Botox injections for wrinkles, chemical peels for anti-aging, and laser hair removal. Elective mole removal solely for cosmetic reasons, without medical concern, also falls into this category.
Routine foot care is not covered by Medicare unless directly related to a medical condition, such as complications from diabetes. Non-medical screenings or preventative services not meeting Medicare criteria are also excluded. Routine full-body skin exams are not covered unless a doctor identifies a suspicious lesion or other medical indications exist.
If a procedure has both cosmetic and medical purposes, only the medically necessary portion may be covered. For example, eyelid surgery (blepharoplasty) or rhinoplasty may be covered if performed to improve vision or correct breathing problems, rather than for aesthetic enhancement. Similarly, removal of excess skin might be covered to prevent infection or skin ulceration.
Understanding Your Costs for Dermatology Care
For dermatology services covered under Medicare Part B, beneficiaries are responsible for out-of-pocket costs. After meeting the annual Part B deductible ($257 in 2025), individuals typically pay a 20% coinsurance of the Medicare-approved amount. For example, on a $100 service, the beneficiary pays $20 after their deductible is met.
Many beneficiaries choose to enroll in a Medicare Supplement, or Medigap, plan to help cover these out-of-pocket expenses. Medigap plans are offered by private insurance companies and can help pay for deductibles, coinsurance, and copayments that Original Medicare does not cover. The specific costs covered by a Medigap plan depend on the plan type.
Medicare Advantage (Part C) plans offer an alternative to Original Medicare, covering all medically necessary services. These plans may have different cost-sharing structures, such as copayments instead of coinsurance, and may require referrals or have network restrictions. Out-of-pocket costs, including premiums, deductibles, and copayments, vary significantly among different Medicare Advantage plans. Beneficiaries should check their specific plan details for dermatology coverage and associated costs.
Additionally, if a dermatologist does not “accept assignment” from Medicare, meaning they do not agree to the Medicare-approved amount, beneficiaries might pay more than the standard 20% coinsurance.