A dermatologist can diagnose and treat skin cancers, melanomas, and other tumors of the skin. And that’s important because more people are diagnosed with skin cancer each year in the U.S. than all other cancers combined.
Dermatologists can also manage cosmetic disorders of the skin. This includes hair loss, scars, and skin changes associated with aging. But does Medicare cover these treatments?
- A dermatologist is a health care professional with a focus on treating skin conditions.
- Dermatological treatments can also extend to hair and nail conditions.
- Medicare Part BMedicare Part B is medical coverage for people with Original Medicare benefits. It covers doctor visits, preventative care, tests, durable medical equipment, and supplies. Medicare Part B pays 80 percent of most medically necessary healthcare services. covers most medically necessaryServices or supplies that are needed for the diagnosis or treatment of your medical condition and meet accepted standards of medical practice. dermatological treatments.
- If you desire treatment for a cosmetic skin condition, such as a mole or birthmark, Medicare does not cover it.
- Medicare Advantage plansMedicare Advantage (MA), also known as Medicare Part C, are health plans from private insurance companies that are available to people eligible for Original Medicare (Medicare Part A and Medicare Part B). will cover skin treatments that are also covered by Original MedicareOriginal Medicare is private fee-for-service health insurance for people on Medicare. It has two parts. Part A is hospital coverage. Part B is medical coverage. (Part AMedicare Part A is hospital coverage for Medicare beneficiaries. It covers inpatient care in hospitals and skilled nursing facilities. It also covers limited home healthcare services and hospice care. and Part B), although out-of-pocket costsOut-of-Pocket Costs for Medicare are the remaining costs that are not covered by the beneficiary's health insurance plan. These costs can come from the beneficiary's monthly premiums, deductibles, coinsurance, and copayments. may differ.
- MedigapMedicare Supplements are additional insurance policies that Medicare beneficiaries can purchase to cover the gaps in their Original Medicare (Medicare Part A and Medicare Part B) health insurance coverage. policies cannot help with cosmetic skin treatments but will help with Medicare-approved treatments.
What Is A Dermatologist?
A dermatologist is a doctor that specializes in diagnosing and treating conditions related to a person’s skin, hair, and nails1Mayoclinic.org, “Dermatology: Overview“, Accessed December 8, 2021. Dermatology covers a wide range of services and treatments, including:2Mayoclinic.org, “Dermatology: Tests & Procedures“, Accessed December 8, 2021
- Allergy education
- Allergy skin tests
- Botox injections
- Chemical peel
- Conscious sedation
- Cosmetic surgery
- Dermal (soft tissue) fillers
- Dermatologic surgery
- Facial fillers for wrinkles
- Laser hair removal
- Laser resurfacing
- Laser surgery
- Light therapy for skin
- Mohs surgery
- Mole removal
- Platelet-rich plasma injections
- Scar revision
- Skin cyst removal
- Tattoo removal
- UV light therapy
How Does Medicare Cover Dermatology?
Medicare Part B generally covers doctor visits when medically necessary to diagnose and treat a skin condition. For most doctor visits, you pay 20% of the Medicare-approved amountA Medicare-approved amount is what Medicare will pay for a covered service. Healthcare providers that agree to Medicare assignment accept the approved amount without excess charges. What Does Medicare-Approved Amount Mean? A Medicare-approved amount is... for the cost of the visit if the doctor accepts Medicare assignmentAn agreement by your doctor to be paid directly by Medicare, to accept the payment amount Medicare approves for the service, and not to bill you for any more than the Medicare deductible and coinsurance..3Medicare.gov, “Diagnostic laboratory tests“, Accessed December 8, 20214Medicare.gov, “Doctor & other health care provider services“, Accessed December 8, 2021
However, Medicare only offers limited coverage of cosmetic procedures. If you are seeing a dermatologist for the treatment of wrinkles or hair loss, for instance, you may not be covered.5Medicare.gov, “Cosmetic surgery“, Accessed December 8, 2021
For example, if you want a mole surgically removed because it is unsightly, it is considered cosmetic and you will have to pay the full price5Medicare.gov, “Cosmetic surgery“, Accessed December 8, 2021. However, if the mole is a symptom of a deeper health condition, it is medically necessary and Medicare will provide coverage for the surgery6Medicare.gov, “Surgery“, Accessed December 8, 2021.
Do Medicare Advantage Plans Cover Dermatology?
Your Medicare Advantage plans will provide coverage for any services covered by Original Medicare (Part A and Part B ). This means that your medically necessary skin treatments are covered by Medicare Advantage, but unnecessary cosmetic surgeries are not covered. For covered skin treatments, your out-of-pocket costs with a Medicare Advantage plan may differ compared to Original Medicare. 7Medicare.gov, “How do Medicare Advantage Plans work?“, Accessed December 8, 2021
Unfortunately, if you wanted Medicare to cover the removal of skin blemishes because it is visually displeasing, you will have to pay the full costs. However, if you are living with a skin condition that requires medically necessary services to treat it, Medicare will pay its share. If you are concerned with an unusual and sudden mark on your skin, consult with your doctor for a dermatologist referral.
- 1Mayoclinic.org, “Dermatology: Overview“, Accessed December 8, 2021
- 2Mayoclinic.org, “Dermatology: Tests & Procedures“, Accessed December 8, 2021
- 3Medicare.gov, “Diagnostic laboratory tests“, Accessed December 8, 2021
- 4Medicare.gov, “Doctor & other health care provider services“, Accessed December 8, 2021
- 5Medicare.gov, “Cosmetic surgery“, Accessed December 8, 2021
- 6Medicare.gov, “Surgery“, Accessed December 8, 2021
- 7Medicare.gov, “How do Medicare Advantage Plans work?“, Accessed December 8, 2021