Dermatology services are typically not covered by Original Medicare. However, if deemed medically necessary, they may be covered. Medicare Advantage (Part C) may offer some coverage, and Part D may cover certain medications.
If you need dermatology care that is a medical necessity for a specific medical condition, you’ll be covered by Original Medicare. However, routine dermatology services and cosmetic procedures are never covered by Original Medicare.
With a Medical Advantage plan, you may have dermatology coverage that goes beyond what original Medicare covers. You can check your specific plan’s coverage for these details or ask about them when signing up.
Keep reading to learn more about what dermatology procedures are covered under Medicare and how to find a Medicare dermatologist.
Dermatology care can be covered under Medicare Part B if it’s shown to be a medical necessity for the evaluation, diagnosis, or treatment of a specific medical condition. This may include preventive screenings or treatments relating to your skin, hair, or nails.
However, an exam by a dermatologist may be covered if it’s directly related to the diagnosis or treatment of a specific illness or injury, such as a skin exam following a biopsy indicating skin cancer.
Depending on the dermatology service or procedure, you may still have to pay a deductible and a percentage of the Medicare-approved amount.
Medicare Advantage (Part C)
Medical Advantage (Part C) may cover additional dermatology services, such as routine checkups and prescription medications. Your insurance provider will be able to give you these details.
You can also check your plan documents to find out if you need a referral from a primary care doctor to see a dermatologist.
To avoid unexpected expenses, always check to make sure that the treatment suggested by your dermatologist is covered by Medicare.
Medications (Part D)
Medicare Part D usually covers prescribed medications, or you may get them covered under a Medical Advantage plan that includes prescription coverage. This can include medications for skin conditions or drugs to treat cancer such as skin cancer.
That said, your out-of-pocket cost can vary depending on your specific plan, and what “tier” your plan places the medication. Some tiers are more costly than others.
To save money, ask your doctor to prescribe a generic version or a specific alternative that is covered under your plan in a more affordable tier.
Because they’re usually not a response to a life threatening situation or other pressing medical need, purely cosmetic procedures, such as treating wrinkles or age spots, are not covered by Medicare.
Usually, Medicare won’t cover cosmetic surgery unless it’s required to improve the functionality of a malformed body part or to repair an injury.
For example, Medicare covers breast reconstruction surgery following a mastectomy due to breast cancer.
If you have a primary care doctor, they commonly have a list of dermatologists they recommend.
You can also find a Medicare dermatologist using Medicare.gov’s physician finder tool. With this tool, you’ll get a list of Medicare dermatologists within a 15-mile radius of your location.
If you have Medicare Advantage, you can either check the insurance provider’s website for a list of in-network dermatologists or contact the company by phone.
Does Medicare require a referral to a dermatologist?
In most cases, you don’t need a referral to see any specialist doctor, such as a dermatologist, to get coverage from Original Medicare. Some Medical Advantage plans may require a referral.
Will Medicare pay to have moles removed?
Medicare will only cover mole removal if the procedure is medically necessary. This means the plan covers it if it’s cancerous, for example, but not if you’re looking to remove it for cosmetic reasons.
Does Medicare cover a full-body skin exam?
Medicare doesn’t cover a full-body skin exam. It only covers one annual wellness visit in which your primary doctor might look at your skin or listen to any skin-related concerns you might have.
To cover dermatology services, Medicare makes a clear distinction between purely cosmetic treatment and medically necessary treatment.
If your doctor has deemed treatment by a dermatologist as medically necessary, it’s likely that Medicare will provide coverage. You should, however, double-check.
If your doctor recommends that you see a dermatologist, ask if the dermatologist accepts Medicare assignment and if the dermatology visit will be covered by Medicare.