February 7th 2024
By Ari Parker
Medicare covers dermatology visits only when you need to treat, diagnose, or prevent a specific medical condition. Explore more in this post.
By Ari Parker
Your skin is your body’s largest organ, and checking in on skin health is important, especially as you age. Aging skin is more prone to thinning, injury, and developing medical conditions. By paying attention to your skin, you can detect and prevent problems like skin cancer and rashes early on.
While Medicare makes it easy to take care of your skin if you develop a specific condition, coverage is limited if you don’t show symptoms of an underlying condition. Medicare insurance generally only covers dermatology visits when they’re medically necessary.
Medicare covers dermatology visits if they’re considered medically necessary. This includes services like skin grafting surgery, allergy skin tests, and treatment for common skin problems, such as psoriasis.
Medicare doesn’t help pay for purely cosmetic procedures, like Botox injections for wrinkles or hair loss treatments.
Medicare only covers skin cancer screenings if you’re showing symptoms. Medicare doesn’t cover routine skin cancer screenings.
If it’s medically necessary, Medicare will cover any dermatological service that you need to treat, diagnose, or prevent a condition. Once you reach your Part B deductible, you’ll pay 20% of any out-of-pocket expenses for covered services. A Medigap plan can significantly reduce your out-of-pocket costs.
Medicare Advantage plans may offer extra coverage for dermatology services. For example, some plans cover preventative screenings and other routine dermatology care.
But Medicare Advantage plans differ. Check your summary of benefits or contact your insurance provider to determine which dermatology services your plan covers and how much you’d have to pay in coinsurance or copays.
Below, we explain some of the specific services and conditions that Original Medicare covers when medically necessary.
Medicare covers allergy skin testing to help determine what substance you’re having an allergic reaction to. Your doctor needs to order this test based on a physical examination.
If you need skin grafting to recover from a burn, infection, or injury, Medicare can help pay for the cost of the surgery. The insurance also covers skin grafting procedures for breast reconstruction surgery following a mastectomy due to breast cancer.
Aging skin is more prone to damage and injury. If your skin is burned, torn, or scabbed, Medicare will pay for procedures to help it recover. Depending on your Part D coverage, you may also be eligible for coverage for prescription treatments, like ointments.
Medicare has comprehensive coverage for cancer treatment, including mole, growth, or lesion removal from your skin.
Medicare covers dermatology visits and treatment for dermatitis, psoriasis, and eczema. Medicare also covers treatment for rosacea, another common skin condition that results in redness in your face.
While Medicare will not cover the removal of skin tags, warts, or moles for cosmetic reasons, it may pay for procedures to remove skin growths if they are painful, bleeding, or require medical attention.
There are some cases in which you may need to undergo a common cosmetic procedure to treat a medically necessary health issue. In these situations, Medicare will cover the dermatological service. Some examples include:
Blepharoplasty: This is a surgery that improves the appearance of your eyelids by removing excess skin, fat, or muscle. It may be medically necessary if drooping eyelids are affecting your vision.
Botox injections: Botox, while also used to reduce wrinkles, can relax muscle tension if you have back or shoulder problems.
Panniculectomy: This is a surgical procedure to remove extra skin and fat from your lower abdomen to improve mobility and hygiene.
Rhinoplasty: This surgery reshapes or enhances the appearance of the nose, which can be necessary after an injury.
Vein ablation: This treats varicose veins by closing or sealing them, which improves blood flow and reduces pain and swelling.
You may need prior authorization before getting these procedures covered by Medicare. Once Medicare approves the request, you’ll only have to pay your deductible and coinsurance.
The American Academy of Dermatology Association says your dermatologist takes care of much of the prior approval process. Here are some more details about the steps:
When your dermatologist writes you a prescription, your pharmacist will run it through your insurance. Then, if prior authorization is needed, your insurance company will contact either you or your dermatologist’s office.
Your dermatologist will submit the information required for prior authorization to Medicare.
Medicare will let you or your dermatologist’s office know if your request was approved. If it’s not approved, then your dermatologist’s office can submit documentation for an appeal.
Most of the time, your dermatologist’s office will take care of prior approval for you. But there are times when you may be given paperwork to complete. Completing this as quickly as possible can help you get approved faster.
Sometimes, Medicare might also contact you about their decisions rather than your dermatologist’s office. Letting your dermatologist’s office know about Medicare’s decision can help you move on to the next steps faster.
When it comes to preventive screenings, Medicare has limited coverage. Medicare will only cover screenings to detect skin cancer if you show signs of cancerous skin growths or moles. It will not cover screenings if you don’t show symptoms of skin cancer, or if you want the test for other reasons.
If you get a skin cancer screening, once you've met your Part B deductible, you’ll pay 20% remaining costs for any doctor’s visit, skin biopsy, or other test for skin cancer. This 20% is your coinsurance, and can be reduced if you have a Medigap plan.
Your coinsurance may also be a different amount if you have a Medicare Advantage plan. Because Medicare Advantage plans vary, you should check your summary of benefits for your policy’s coinsurance amount.
In general, Medicare won’t cover any service, including dermatology visits, for purely cosmetic reasons. These procedures include:
Removing benign lesions and skin tags
Botox injections for wrinkles
Hair loss treatments if you don’t have a medical issue
Facial cosmetic surgery
Body-altering surgeries like liposuction, tummy tucks, and breast enhancement
To find a dermatologist who accepts Medicare, you can use the Care Compare tool on Medicare’s website. You’ll input your state, city, ZIP code, or street name. You can then search for the dermatology specialty to find dermatologists who accept Medicare. You can filter results by distance, gender, telehealth availability, and certification.
Medicare’s website is helpful for finding providers that accept Original Medicare. But if you have a Medicare Advantage plan, the process is different. Medicare Advantage plans have different networks, meaning that you’ll have access to different doctors. Contact your plan for help finding a dermatologist in your plan’s network.
Whether or not Medicare can cover dermatology is a common question. The line between cosmetic and non-cosmetic can be tricky to identify, especially when cosmetic procedures can be used to treat certain medical conditions.
Talking to a licensed Medicare Advisor is a good way to understand your plan and use it to reduce your healthcare costs. Call 855-900-2427 or schedule a chat today to get your Medicare questions answered and feel confident in your coverage.
