Does Medicare Cover Skin Cancer Removal?

Medicare generally offers coverage for the diagnosis and treatment of skin cancer when such care is deemed medically necessary. This coverage helps beneficiaries manage the financial aspects of addressing cancerous or precancerous skin conditions.

Medicare’s Approach to Skin Cancer Care

Medicare’s framework for skin cancer coverage centers on “medically necessary” care. This means services are covered if required to diagnose or treat an illness, injury, condition, disease, or its symptoms, and meet accepted standards of medical practice. For skin cancer, this includes procedures for lesions identified as cancerous or having a high potential to become cancerous. Coverage extends to common types of skin cancer, such as basal cell carcinoma, squamous cell carcinoma, and melanoma.

The program also covers the removal of precancerous skin lesions, such as actinic keratoses. These lesions, resulting from sun exposure, have the potential to develop into squamous cell carcinoma if left untreated. While routine, asymptomatic skin cancer screenings may not be covered, Medicare does cover doctor visits if a beneficiary notices suspicious changes to their skin, leading to a diagnostic investigation.

Coverage Details Under Original Medicare

Original Medicare, which includes Part A (Hospital Insurance) and Part B (Medical Insurance), provides coverage for skin cancer removal. Most procedures are performed in an outpatient setting, falling primarily under Medicare Part B. This includes a range of surgical techniques to remove cancerous or precancerous lesions.

Medicare Part B covers procedures such as surgical excision, where cancerous tissue and a margin of healthy skin are cut away. Mohs micrographic surgery, a precise technique involving layer-by-layer removal and immediate microscopic examination of tissue until no cancer cells remain, is also covered. Other methods include cryosurgery, which uses extreme cold to destroy abnormal tissue, and curettage and electrodesiccation, involving scraping away the lesion and using an electric current.

Diagnostic services are also covered under Part B, including initial visits to a doctor or dermatologist for evaluation of suspicious growths. If a growth is suspected to be cancerous, Medicare covers biopsies for laboratory analysis. Pathology lab tests, essential for confirming a diagnosis, are also included. Follow-up care, such as wound checks and post-operative visits, is covered as part of the overall treatment plan. In rare instances where complex skin cancer removal requires an inpatient hospital stay, Medicare Part A provides coverage for the hospital services.

Patient Financial Responsibility

Under Original Medicare, beneficiaries have financial responsibilities for skin cancer removal and related services. For services covered by Medicare Part B, an annual deductible applies. In 2025, the Medicare Part B annual deductible is $257. This amount must be paid out-of-pocket before Medicare begins to cover its share of approved services.

After the deductible has been met, beneficiaries are responsible for a 20% coinsurance of the Medicare-approved amount for most Part B services. This 20% coinsurance applies to doctor’s fees, surgical facility charges (if the procedure is performed in an outpatient surgical center), and diagnostic tests such as biopsies and pathology. For example, if a skin cancer removal procedure has a Medicare-approved cost of $1,000 after the deductible, the beneficiary would pay $200. These costs can accumulate, especially if multiple procedures or follow-up visits are necessary.

Medicare Advantage and Skin Cancer Coverage

Medicare Advantage Plans, also known as Medicare Part C, are offered by private insurance companies approved by Medicare. By law, these plans must provide at least the same level of coverage as Original Medicare (Parts A and B). Therefore, Medicare Advantage plans cover medically necessary skin cancer removal procedures, including the diagnostic services and treatments covered by Original Medicare.

While the scope of covered services is similar, the administration and cost-sharing structures can differ significantly from Original Medicare. Medicare Advantage plans often utilize copayments instead of the 20% coinsurance in Part B, meaning beneficiaries might pay a fixed dollar amount per service. These plans also have their own deductibles and an annual out-of-pocket maximum, which limits the total amount a beneficiary pays for covered services in a calendar year. Network restrictions are common, with Health Maintenance Organization (HMO) plans generally requiring beneficiaries to use in-network providers, while Preferred Provider Organization (PPO) plans offer more flexibility at a potentially higher cost for out-of-network care. Some plans may also require prior authorization for certain procedures, necessitating approval from the plan before services are rendered.

Supplemental Coverage and Prescriptions

For those with Original Medicare, supplemental insurance options can help manage out-of-pocket costs related to skin cancer treatment. Medigap, or Medicare Supplement Insurance, plans are sold by private companies and help cover the “gaps” in Original Medicare coverage. These plans can pay for deductibles, coinsurance, and copayments that Original Medicare does not cover, significantly reducing a beneficiary’s financial burden for skin cancer removal and associated care.

Medicare Part D provides prescription drug coverage, which can be relevant for skin cancer treatment, although less common for simple excisions. Part D plans cover medications that may be prescribed before or after a procedure, such as pain relievers or antibiotics to prevent infection. For more complex cases, such as certain types of skin cancer requiring chemotherapy, Part D may cover oral chemotherapy drugs if not covered by Part B. In 2025, beneficiaries enrolled in a Part D plan will have an annual out-of-pocket cap of $2,000 for covered prescription drugs.