Does Medicare Cover Dermatology Services?

Navigating healthcare coverage, especially for specialized services like dermatology, can be complex. This article clarifies how Medicare addresses dermatology needs, including services, costs, and what individuals can expect. Coverage hinges on the medical necessity of the service provided.

Medicare Coverage Basics

Medicare Part B, known as medical insurance, covers medically necessary services and outpatient care. This includes doctor visits, outpatient therapy, and certain preventive services. For a service to be considered medically necessary, it must be required for the diagnosis or treatment of a disease, injury, condition, or for the improvement of a malformation of a body function. Part B participants pay a monthly premium, an annual deductible, and coinsurance for covered services.

Individuals can choose a Medicare Advantage Plan (Part C) as an alternative to Original Medicare. These plans are offered by private companies approved by Medicare, and they must cover at least everything Original Medicare Parts A and B cover. Many Medicare Advantage plans offer additional benefits, such as prescription drug coverage, and may have different cost-sharing structures like copayments or coinsurance.

Medigap policies, sold by private companies, can help cover some of the out-of-pocket costs associated with Original Medicare, such as coinsurance, copayments, or deductibles. Medigap plans do not work with Medicare Advantage plans.

Dermatology Services Covered by Medicare

Medicare covers dermatology services if medically necessary for the diagnosis or treatment of illnesses or conditions. This includes examinations and treatments for skin diseases like psoriasis, eczema, or acne that require medical intervention. Biopsies performed to diagnose suspicious skin lesions, such as those indicating potential skin cancer, are also covered.

Routine skin cancer screenings, when prescribed by a doctor due to a medical concern or risk factor, are included as medically necessary services. For instance, if a dermatologist removes a wart because it is painful or infected, this procedure would be covered. The distinction between medical and cosmetic necessity is important for coverage.

Conversely, procedures purely for cosmetic purposes are not covered by Medicare. This includes services aimed at improving appearance without a medical indication, such as wrinkle fillers or laser treatments for age spots. While some treatments may have both cosmetic and medical applications, Medicare coverage is determined solely by the medical necessity of the procedure. For example, the removal of a benign mole for purely cosmetic reasons would not be covered.

Costs and Accessing Dermatology Care

Under Original Medicare, individuals are responsible for the Part B deductible before coverage begins for most services. After the deductible is met, Medicare pays 80% of the Medicare-approved amount for most doctor’s services and outpatient therapy. The individual is responsible for the remaining 20% coinsurance.

Medicare Advantage plans have their own cost-sharing structures, which include copayments or coinsurance for specialist visits, such as a dermatologist. These costs vary significantly between plans and may include a fixed copayment for each visit, such as $30-$50. Individuals should review their specific plan documents to understand their financial responsibilities.

To find a dermatologist who accepts Medicare, confirm their participation with either Original Medicare or your specific Medicare Advantage plan. Most dermatologists accept Original Medicare, and those who accept “assignment” agree to Medicare’s approved amount as full payment. While Original Medicare does not require referrals to see a specialist, some Medicare Advantage plans, particularly Health Maintenance Organizations (HMOs), require one from a primary care physician before visiting a dermatologist.