Does Medicare Cover Dermatology Exams?

Medicare is a federal health insurance program for individuals aged 65 or older, and certain younger people with disabilities or specific medical conditions. When considering dermatology exams and treatments, Medicare coverage is primarily determined by medical necessity. This means services must be required to diagnose or treat a health condition, rather than for cosmetic reasons. Understanding these distinctions helps beneficiaries navigate their healthcare options.

Covered Dermatology Services

Medicare Part B, which covers medical insurance, generally provides coverage for dermatology services deemed medically necessary. This includes the diagnosis and treatment of various skin conditions such as acne, eczema, psoriasis, and rashes. For instance, if a dermatologist evaluates and biopsies a suspicious mole or lesion due to concerns about potential skin cancer, Medicare Part B typically covers these services. Follow-up care for diagnosed skin cancers, including procedures for removal or management, is also covered. Additionally, dermatological procedures performed for medical reasons, such as cryotherapy for precancerous lesions or the removal of medically problematic cysts, fall under Medicare Part B coverage.

Dermatology Services Not Covered

Medicare typically does not cover dermatology services that are not considered medically necessary. This primarily includes cosmetic procedures, which are performed solely to improve appearance without addressing a functional impairment or medical condition. Examples of such procedures not covered include Botox injections, dermal fillers, laser hair removal for cosmetic purposes, and chemical peels performed for aesthetic reasons. Routine skin screenings without a medical indication or specific symptoms are also generally not covered by Medicare.

Understanding Your Costs

For covered dermatology services, beneficiaries with Original Medicare typically have financial responsibilities under Medicare Part B. After meeting the annual Part B deductible, which is $257 in 2025, patients generally pay a coinsurance amount. This coinsurance is usually 20% of the Medicare-approved amount for the service. Medicare then pays the remaining 80% of the approved amount.

Many healthcare providers accept Medicare assignment, meaning they agree to accept the Medicare-approved amount as full payment for the service. This often translates to lower out-of-pocket costs. Medicare Supplement (Medigap) plans or Medicare Advantage (Part C) plans may also affect out-of-pocket costs by providing additional coverage or different cost-sharing structures.

Preparing for a Dermatology Visit

Before a dermatology appointment, patients should take several steps to help ensure a smooth experience regarding Medicare coverage. It is advisable to verify that the dermatologist accepts Medicare assignment. This confirms the provider agrees to Medicare’s approved payment rates, which can reduce your personal financial responsibility.

Understanding whether a referral from a primary care physician is necessary for your specific Medicare plan is also important. While Original Medicare generally does not require referrals for specialist visits, some Medicare Advantage plans may have such requirements. Discussing the purpose of your visit with the dermatologist’s office staff beforehand can help clarify if the service is likely to be covered by Medicare. Maintaining records of your visits and associated costs is also beneficial for personal financial tracking.