What to Know About Medicare and Dermatology

• Original Medicare coverage does not include routine dermatology visits and cosmetic procedures within its plans. Medicare Part B will cover dermatology services so long as they’re deemed medically necessary, however.

• Dermatology services and dermatology procedures may be covered by Medicare Advantage as one of its additional benefits. These additional benefits will vary depending on the specific MA plan chosen.

Skin health is important. After all, as the body’s largest organ, the skin protects the body from external factors such as bacteria, chemicals, and temperature. The skin also provides defenses against ultraviolet light as well as helps to regulate body temperature.

Skin diseases are incredibly common. In fact, skin diseases impact one in four Americans annually. Given the prevalence of skin disorders, and their associations with health, does Medicare cover dermatology visits and services? 

In short, no, Original Medicare doesn’t cover routine dermatology visits. Medicare’s medical insurance may cover dermatology-related services if it is shown to be a medical necessity. Medicare Advantage may also cover dermatology services as one of its extra benefits. 

This is everything Medicare beneficiaries need to understand about Medicare and dermatology.

Dermatology is a branch of medicine that involves skin health and associated conditions. Doctors who practice dermatology are called dermatologists. A dermatologist is a type of doctor who specializes in skin, hair, and nail conditions.

What Skin Conditions Can A Dermatologist Treat?

A dermatologist can diagnose and treat a variety of conditions. In fact, they can actually diagnose and treat more than 3000 types of skin conditions, but the most common include:

• Skin cancer

• Eczema

• Psoriasis

• Shingles

• Vitiligo

• Ingrown nails

• Rosacea

• Hair loss

• Fungal infections

• Acne

• Warts

• Cellulitis

What Types Of Dermatology Services Are There?

There are various types of dermatology services. Some of these include: 

• Acne treatment

• Cosmetic services (i.e. laser hair removal) 

• Skin cancer screening and treatment, including melanoma

• Wart removal

• Diagnosis and treatment of various skin conditions such as psoriasis, rosacea, moles and birthmarks, eczema, dry skin, etc.

• Diagnosis and treatment of various nail conditions such as fungal infections

As a reminder, the Federal Medicare Program consists of Medicare Part A (hospital insurance) and Medicare Part B (medical insurance). These are referred to as Original Medicare and each Medicare Part is responsible for different healthcare services. 

Medicare Part A covers inpatient healthcare services while Medicare Part B covers outpatient healthcare services. These do not provide coverage for prescription drugs, however. Medicare patients would need to enroll in a Medicare drug plan, known as Medicare Part D, to obtain coverage for prescription medications.

Original Medicare coverage does not cover routine dermatology visits, cosmetic services, or cosmetic surgery. 

Dermatology Services Medicare Covers

That said, Medicare covers dermatology services in specific situations under Medicare Part B. Medicare Part B covers dermatology services only in the event they are deemed medically necessary. Some such services that fit this definition would be: 

• Skin cancer treatment 

• Cosmetic surgery following an accident

Note: The Medicare beneficiary should always consult their primary care physician prior to making a dermatology appointment to determine medical necessity.

Cost of Dermatology Services With Medicare

In the event a dermatology appointment is needed, beneficiaries can expect to pay 20% of the Medicare-approved amount for whatever service was necessary. The Part B deductible applies as well.

Medicare Advantage plans, also known as Medicare Part C or MA plans, are Medicare plans that bundle Medicare Part A and Medicare Part B coverage. A Medicare Advantage plan usually includes Medicare Part D (prescription drug coverage) within its coverage as well.

In addition to coverage for prescription drugs, Medicare Advantage plans typically also include additional benefits including hearing, vision, and dental. There are a number of other benefits that may be offered as well, including dermatology services. 

Exact benefits will always vary per Medicare Advantage plan. Interested parties should always check with their insurance company or licensed insurance agents to confirm extra perks.

Medicare supplement insurance, also known as Medigap or MedSupp, are supplemental Medicare plans that help ​“fill in the gaps” of Original Medicare. It may help pay some of the costs for dermatology.

Many Medigap policies are sold by private insurance companies and help pay some out-of-pocket costs such as deductibles, coinsurance, and copays. This may include the Medicare Part B deductible, which, in turn, would cover medically necessary dermatology services. 

Does Medicare cover full-body skin exams?

If the exam is done by a primary care physician or a referred dermatologist as part of an annual preventive care check-up, it’s likely Medicare Part B will cover the exam.

Will Medicare cover skin tag or mole removal?

If any mark on the body (mole, skin tag, rash, etc.) appears to be harmful or cancerous, Medicare will cover a biopsy and necessary treatment of the issue. However, if the biopsy comes back benign, Medicare will not cover cosmetic removal of any moles, tags, etc.