- 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 medically necessary.
- If you’ve enrolled in Medical Advantage (Part C), you may have dermatology coverage, along with other additional coverage.
- If your doctor recommends that you consult a dermatologist, ask ahead of time if visit will be covered by Medicare.
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. However, depending on the dermatology service or procedure, you may still have to pay a deductible and a percentage of the Medicare-approved amount.
For example, a routine full-body skin exam isn’t covered by Medicare.
The exam may be covered if it’s directly related to the diagnosis or treatment of a specific illness or injury. Typically, Medicare will pay for a skin exam following a biopsy indicating skin cancer.
Depending on the dermatology procedure, you may still have to pay a deductible and a percentage of the Medicare-approved amount.
Medicare Advantage coverage
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 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.
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 will 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.
- 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.