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I spent a lot of time over my life out in the sun. Because of that, I have a lot of sunspots – I guess you would call them. I’m worried about them and think I should see a dermatologist. But I’m not sure if this kind of thing is covered. I’m wondering, does Medicare cover dermatology?
Regretting the sun worship,
Janet from Miami, Florida
I’m so glad that you’re asking this question. You’re not alone in the sun worshiping, but people over 65 face a higher melanoma, or skin cancer, rate.
As you age, the risk of melanoma increases. In fact, according to the Skin Cancer Foundation, one in five Americans will develop skin cancer by the time they’re 70. And although Melanoma accounts for about 1% of skin cancers, it causes a large portion of skin cancer deaths. The average age of Melanoma diagnosis is 65.
If you were exposed to a lot of sun throughout your life, you can still make healthy choices now. When you go outside, you can stay in the shade, use sunscreen, wear a wide-brimmed hat, wear clothing to the ankles, and/or wear a long-sleeved shirt. All of these efforts can help reduce your chances of melanoma.
“Original Medicare Part B covers medically necessary dermatology, and does not cover procedures that are purely cosmetic.“
Now, is dermatology covered by Medicare? The answer is maybe and sometimes. Really clear, right? Original Medicare does not cover cosmetic dermatology, but there is coverage. Dermatology is generally covered by Original Medicare Part B’s medical insurance.
With Medicare Part B, you can receive a full-body skin exam to detect skin cancer or other skin-related conditions. The exam must be performed by a primary care physician or a dermatologist. If a suspicious spot or growth is found, Medicare may also cover a biopsy for testing.
You may be required to pay the Medicare Part B deductible and 20% of the Medicare-approved exam, while Medicare pays the remaining 80%. To avoid excessive charges, ensure that the healthcare provider who does the exam and any biopsies accepts Medicare.
To reduce your costs you can choose to enroll in a Medicare Supplement or Medicare Advantage plan. A Medicare Supplement plan will help pay for some or all of the 20% coinsurance. A Medicare Advantage plan provides equal coverage of Medicare Part B but with different deductibles, a maximum out-of-pocket, and oftentimes, better benefits. In order to avoid financial risk, most people choose to expand their coverage with one of these plans.
As for other dermatology exams or procedures, Medicare Part B may or may not cover them. That’s because the dermatology visit or service must be considered medically necessary.
Medically necessary dermatology may include:
There are some grey areas where a cosmetic procedure may be both cosmetic and medically necessary. Medicare covers dermatology services as long as they’re medically necessary. Examples could include:
You can expect things like a facelift, laser hair removal, liposuction, or a tummy tuck to not be covered by Medicare.
I hope that this answered your questions and helped you understand what types of dermatology are and aren’t covered by Medicare insurance plans. Please reach out should you have any additional questions. We’re here to support you throughout your Medicare journey.
And if you need help deciding if a Medicare Supplement or Medicare Advantage plan could help reduce your costs, let us know. A licensed Connie Health agent, in your community, can walk you through plan options and find one suited for your health and budget—call (623) 223-8884 to speak with a local agent.
The answer to the question, “Does Medicare cover dermatology cancer screening?” is Yes. Medicare covers diagnostic tests and preventive screenings deemed necessary to diagnose or prevent diseases. Dermatology cancer screening is a preventative screening covered by Medicare Part B. The dermatology cancer screening must be performed by a dermatologist or other qualified healthcare professional who accepts Medicare payments.
However, it’s essential to know that Medicare covers 100% of the cost of the preventive screening only when the doctor accepts Medicare payments. In addition, If the dermatologist finds a potential skin cancer or other skin problems during the screening, the cost of any extra tests or treatments might not be entirely covered by Medicare. After the Part B deductible has been met, you will have to pay 20% of the Medicare-approved amount for doctor services.
The preventive screening covers a visual examination of the entire body, including the scalp, hair, and nails, to check for abnormalities that might suggest skin cancer or other skin issues. However, if you want extra tests, like biopsies or other treatments that aren’t necessarily preventive care, Medicare might not cover the entire cost.
It’s essential to know that Medicare only covers preventive care or medically necessary treatments. If the dermatology cancer screening is done for cosmetic reasons, Medicare won’t cover it. Cosmetic procedures such as mole removal, and skin rejuvenation are not covered by Medicare.
Medicare Part B, often referred to as medical insurance, covers medically necessary services such as doctor visits, lab tests, and other outpatient services. This includes dermatology visits, which can be covered if deemed medically necessary. This means that if the dermatologist orders a test, procedure, or treatment necessary for the diagnosis or treatment of a medical condition, it will be covered by Medicare. However, cosmetic procedures or treatments are generally not covered by Medicare.
If you have Original Medicare (Part A and Part B), you will be responsible for paying the annual deductible, which Medicare sets. After you meet your deductible, Medicare will cover 80% of the Medicare-approved amount for the service, and you will be responsible for the remaining 20%. Furthermore, if your dermatologist decides to prescribe medication for your skin condition, this may also be covered under Medicare Part D, the prescription drug coverage component of Medicare.
It is important to note that some dermatology procedures, such as mole removal, may be considered “personal comfort” services and not covered by Medicare. In addition, while some preventive skin care measures are covered under Medicare, they are generally limited to screenings for skin cancer and not other skin problems.
Medicare covers a range of dermatology procedures. Knowing which procedures are covered can help ease financial worries and ensure you receive the necessary care to maintain healthy skin. Medicare covers medically necessary dermatology visits and procedures, including skin cancer screenings, biopsies, medically necessary treatment of skin conditions, the removal of benign skin lesions, wound care, and more.
Read more by William Revuelta
I am a Spanish-speaking Florida Life and Health Insurance Licensed Agent and have been helping people with Medicare since 2009. I’m an avid sports fan and enjoy watching international soccer matches and college football. When not with my family, I listen to podcasts ranging from history to sports talk.