Does Medicare Cover Psoriasis Treatment?

Psoriasis is a common chronic autoimmune condition causing skin inflammation and scaling. Managing this condition often requires ongoing medical care and various treatments. Medicare, the federal health insurance program, helps eligible individuals cover the costs associated with psoriasis care. This article outlines how Medicare covers psoriasis treatments, including services and medications under different parts of the program.

Original Medicare Coverage for Psoriasis Treatments

Original Medicare (Part A and Part B) covers various aspects of psoriasis treatment. Part A covers inpatient hospital care for severe psoriasis flares. It also covers skilled nursing facility care and certain home health services if medically required after a hospital stay. Most psoriasis treatment occurs on an outpatient basis.

Medicare Part B covers most outpatient psoriasis care. It includes medically necessary doctor visits for diagnosis, monitoring, and treatment. Outpatient light therapy (phototherapy) is also covered. Additionally, certain injectable or infused medications administered in a doctor’s office or clinic fall under Part B. Part B also covers durable medical equipment and laboratory tests.

For Part B services, beneficiaries must first meet an annual deductible, which is $257 in 2025. After the deductible, Medicare typically pays 80% of the approved amount. The beneficiary is responsible for the remaining 20% coinsurance, which has no annual out-of-pocket maximum under Original Medicare.

Prescription Drug Coverage for Psoriasis

Medicare Part D covers medications typically self-administered or taken at home for conditions like psoriasis. These plans are offered by private insurance companies approved by Medicare. Part D plans include various psoriasis medications, such as oral drugs, topical creams, and self-injectable biologics, listed on their formularies.

Each Part D plan has a formulary, a list of covered drugs categorized into tiers that determine cost-sharing. The cost of psoriasis medications varies significantly between plans, making formulary review important. In 2025, the standard Part D deductible is $590, though some plans may offer a lower deductible. After meeting the deductible, beneficiaries typically pay 25% of drug costs in the initial coverage phase.

For 2025, the coverage gap (or “donut hole”) is eliminated, meaning beneficiaries will not face higher costs in that phase. Instead, once out-of-pocket spending, including deductible and coinsurance, reaches $2,000 in 2025, beneficiaries enter the catastrophic coverage phase. In this phase, there is no further cost-sharing for covered Part D drugs for the rest of the year.

Medicare Advantage Plans and Psoriasis Care

Medicare Advantage Plans (Part C) offer an alternative way to receive Medicare benefits. These plans are provided by private companies and must cover all services Original Medicare (Part A and Part B) covers. Many plans also include prescription drug coverage (Part D) and additional benefits.

Coverage for psoriasis treatment under a Medicare Advantage plan can differ from Original Medicare. Plans may have network restrictions, such as HMOs, or offer more flexibility with PPOs. Some plans may also require referrals to see specialists like dermatologists.

Cost-sharing structures vary, including premiums, copayments, and deductibles. Unlike Original Medicare, all Medicare Advantage plans have an annual out-of-pocket maximum for Part A and B services. Because specific rules, formularies, and costs differ significantly, reviewing individual plan details is important for understanding psoriasis treatment coverage.

Supplemental Coverage for Psoriasis Costs

Medigap offers a way to manage some out-of-pocket costs associated with Original Medicare. These policies are sold by private companies and work in conjunction with Original Medicare, not as a replacement. Medigap plans help pay for healthcare costs Original Medicare does not fully cover, such as deductibles, copayments, and coinsurance for Part A and Part B services.

For individuals with Original Medicare, a Medigap policy can reduce the financial burden of the 20% Part B coinsurance, which has no annual limit. For example, a Medigap plan could cover the 20% coinsurance for phototherapy or injectable medications. Medigap policies do not cover prescription drugs; a separate Medicare Part D plan is required for drug coverage.

Different Medigap plans, identified by letters (e.g., Plan G, Plan N), offer varying levels of coverage for these costs. Benefits for each plan type are standardized across states, meaning a Plan G offers the same core benefits regardless of insurer. These policies help fill the “gaps” in Original Medicare’s coverage, providing more predictable healthcare expenses for chronic conditions like psoriasis.