Routine dermatology services are not covered by original Medicare (Part A and Part B).
Dermatology care may be covered by Medicare Part B if it’s shown to be a medical necessity for the evaluation, diagnosis, or treatment of a specific medical condition. However, depending on the dermatology procedure, you may still have to pay a deductible and a percentage of the Medicare-approved amount.
If you’ve enrolled in a Medical Advantage plan (Part C), you may have dermatology coverage along with other additional coverage, such as vision and dental.
Your insurance provider will be able to give you details. Also, you can check your Medical Advantage plan to find out if you need a primary care doctor referral to see a dermatologist.
Keep reading to learn more about what dermatology procedures are covered under Medicare, and how to find a Medicare dermatologist.
To avoid unexpected expenses, always check to make sure that the treatment suggested by your dermatologist is covered by Medicare.
For example, a routine full-body skin exam isn’t covered by Medicare.
At this site, run by the U.S. Centers for Medicare and Medicaid Services, you can:
- Enter your city and state in the “Enter your location” area.
- Enter “dermatology” in the “Search for a name, specialty, group, body part, or condition” area.
- Click on “Search.”
You’ll get a list of Medicare dermatologists within a 15-mile radius.
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, according to the U.S. Centers for Medicare and Medicaid Services, following a mastectomy due to breast cancer, Medicare Part B covers some external breast prostheses, such as a post-surgical bra.
Medicare Part A and B cover surgically implanted breast prostheses following a mastectomy:
- surgery in an inpatient setting would be covered by Part A
- surgery in an outpatient setting would be covered by Part B
One way to quickly determine if a dermatology procedure is covered by Medicare is to go to Medicare.gov’s coverage page. On the page, you’ll see the question, “Is my test, item, or service covered?”
Under the question is a box. Enter into the box the test, item, or service you are curious about and click “Go.”
If your results do not give you exactly the information you need, you can use them to further refine your search. For example, if the procedure you’re interested in has another medical name, you can use that name in your next search.
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.