Does Medicare Cover Dermatology Visits?

Medicare, a federal health insurance program, provides coverage for individuals aged 65 or older, and for younger people with certain disabilities. Understanding the scope of this coverage, particularly for specialized medical fields like dermatology, is a common concern for beneficiaries. This article clarifies when and how Medicare covers dermatology visits, emphasizing that coverage primarily depends on the medical necessity of the services received.

Core Coverage for Medically Necessary Visits

Medicare generally covers dermatology services when they are considered “medically necessary,” meaning they are required for the diagnosis or treatment of a disease, injury, condition, or its symptoms. Medicare Part B, which is the medical insurance component, is the primary source of coverage for outpatient dermatology visits and procedures. This includes a wide range of services for skin, hair, or nail conditions.

Examples of medically necessary dermatology services include the diagnosis and treatment of skin conditions such as acne, eczema, psoriasis, and rosacea. Coverage also extends to checking suspicious moles, performing biopsies for cancerous tissue, and treating skin cancer. Procedures like cryotherapy, which uses extreme cold to remove skin growths, and the surgical removal of malignant or problematic skin lesions are also covered.

What is Not Covered

While Medicare covers medically necessary dermatology services, it generally does not cover procedures performed solely for cosmetic purposes. This exclusion applies to services intended to enhance appearance rather than to diagnose or treat a medical condition. For instance, treatments for wrinkles, age spots, or non-medical skin tag removal are typically not covered.

Specific examples of cosmetic dermatology treatments usually excluded from Medicare coverage include injectable treatments like Botox or dermal fillers, laser and light devices for skin rejuvenation, and facial cosmetic surgery such as facelifts. Hair loss treatments are not covered unless the hair loss stems from an underlying medical condition. If a mole removal is desired solely for appearance and is not deemed suspicious, Medicare will not cover the procedure.

How Different Medicare Parts Affect Coverage

Medicare coverage for dermatology visits can vary depending on the specific parts of Medicare a beneficiary has. Medicare Part B covers outpatient dermatology services, including doctor’s appointments, diagnostic tests like biopsies, and various outpatient treatments. Once the annual Part B deductible is met, Medicare typically pays 80% of the Medicare-approved amount for these services, leaving the beneficiary responsible for the remaining 20% coinsurance.

Medicare Advantage plans (Part C) are offered by private companies approved by Medicare and must provide at least the same level of coverage as Original Medicare (Parts A and B). These plans may have different cost-sharing structures, such as copayments for specialist visits, and often operate with specific provider networks or may require referrals. Beneficiaries should review their specific plan details to understand their benefits and requirements.

Medicare Part D provides prescription drug coverage, which can be relevant if a dermatologist prescribes medications for a skin condition. This includes creams, ointments, or oral medications, but coverage depends on whether the drug is on the plan’s formulary (its list of covered medications). Medicare Part A, which covers hospital insurance, is relevant for dermatology only if a severe skin condition or related procedure necessitates an inpatient hospital stay.

Understanding Your Costs

Understanding the financial obligations associated with dermatology visits under Medicare is important for beneficiaries. For services covered under Medicare Part B, an annual deductible must be satisfied before Medicare begins to pay its share. In 2025, the standard Part B deductible is $257. After meeting this deductible, beneficiaries are typically responsible for a 20% coinsurance of the Medicare-approved amount for most Part B services, including dermatology visits.

Medicare Advantage plans often feature copayments for doctor visits, which are fixed dollar amounts paid at the time of service. These copayment amounts can vary significantly depending on the specific plan and whether the dermatologist is in the plan’s network. When a healthcare provider accepts “assignment,” they agree to accept the Medicare-approved amount as full payment, meaning they can only bill the patient for the deductible and coinsurance. Some providers are “non-participating,” meaning they accept Medicare patients but have not signed an agreement to accept assignment, and may charge up to 15% above the Medicare-approved amount; this extra charge is known as an excess charge.

To manage out-of-pocket costs, many beneficiaries purchase Medigap, or Medicare Supplement Insurance. These policies are offered by private companies and help cover some expenses Original Medicare does not, such as deductibles, copayments, and coinsurance. The coverage provided by a Medigap policy depends on the plan chosen. It is advisable to verify coverage and potential costs with your Medicare plan or healthcare provider before receiving dermatology services.