If you’re struggling to understand Medicare, Connie can help. Ask Connie your question, and a local, licensed agent will help you navigate your Medicare journey. Complete this form to have your question answered. It could be featured on Dear Connie.
I admit that I’ve spent a fair amount of time out in the sun, and my skin is paying the price. I’ve noticed some concerning sun spots and would like to get them checked out by my doctor, but I’m worried about the cost. I wonder, does Medicare cover skin cancer screenings?
Sandra from Laguna Woods, California
Thank you for writing and asking this question. I’m sure many other people are wondering if Medicare covers skin cancer screenings.
Since you didn’t mention where these sunspots are located, let’s review the most common types of skin cancer and where they can be found. The three most common skin cancers are basal cell carcinoma, squamous cell carcinoma, and melanoma.
Basal cell carcinoma is the most common type of skin cancer and is responsible for eight in 10 skin cancers. You can typically find basal cell carcinomas develop on your face, head, and neck. These cancers start in the outer layer of your skin, grow slowly, and do not spread to other parts of the body. However, if left untreated, it could destroy underlying cells, tissues, and bone.
There are three subtypes of basal cell carcinoma to look out for: nodular, superficial, and pigmented. Nodulars are small rounded lumps, superficial on the skin’s surface, and pigmented means that it has color – and this type can look a lot like melanoma, which is a much more dangerous cancer.
Squamous cell carcinoma accounts for two in 10 skin cancers. Look on your face, ears, lips, neck, and the back of your hands to find this type of cancer. These cancers should be treated and removed to prevent the cancer from spreading to other parts of the body.
While the risk of spreading to other parts of the body is low, you should check yourself regularly for flat cells on the skin’s surface that have had regular exposure to the sun for long periods of time, wounds that take a long time to heal, or scars from burns or radiation.
Melanoma is the most dangerous type of skin cancer because it has the most significant risk of spreading to other parts of the body. It’s also most frequently diagnosed among people aged 65-74, with the average age of diagnosis being 66. Men are more likely to get melanoma, and by the age of 65, men are two times more likely than women to get melanoma. By the time they turn 80, men are three times more likely than women to develop melanoma.
It begins as colored, unusual-looking growths with uneven borders and colors. If caught early, nearly all melanomas can be cured. But in later stages, when it spreads to the brain, lungs, and intestines, among other parts, it can be difficult to treat. Melanoma is caused by various factors, including exposure to the sun or tanning beds and genetic and environmental factors.
Because you’ve found some sunspots, you should visit your doctor. We want to ensure they are none of the skin cancers we mentioned above or others. While Medicare does not cover regular preventative skin cancer screenings, it may cover services or tests related to diagnosing and treating skin cancer.
“Medicare covers skin cancer screenings when there is a localized abnormal skin change or growth. It does not cover full-body cancer screenings that are not medically necessary.“
For example, Original Medicare Part B and Medicare Advantage plans may cover skin cancer screenings and tests that can help rule out or diagnose skin cancer as long as they are medically necessary and the provider accepts Medicare assignment. It would also cover a doctor’s visit to check a mole or the sunspots you mentioned. So, since you have spots that concern you, Medicare Part B would provide coverage.
Medicare Part B would not cover a general skin cancer screening if you weren’t showing any signs of skin cancer. However, if your primary care doctor notices an abnormal change in the color of a mole or a new skin growth, a cancer screening may be covered by Medicare. Part B will cover visiting the dermatologist if you are referred for additional testing or analysis for a potentially cancerous skin growth.
While Medicare Part B may cover skin cancer screenings, there are costs. You would need first to pay the Medicare Part B deductible. Once that is paid, you would owe 20% coinsurance for the Medicare-approved amount of covered dermatological services. To help with these costs, you may choose to have a supplemental insurance plan such as a Medicare Supplement (Medigap) or Medicare Advantage plan.
A Medicare Supplement insurance plan helps pay for some or all of the out-of-pocket costs of Medicare, while a Medicare Advantage plan provides an out-of-pocket maximum, along with extra benefits. It could also provide additional coverage or benefits for skin cancer screenings and appointments.
If you want to get your potentially cancerous sunspots checked out, you should see your primary care physician or a dermatologist. If you have more questions about skin cancer coverage or Medicare plans, our local licensed agents are happy to help.
Speak with a local licensed agent today—call (623) 223-8884. We’re here to support you throughout your Medicare journey.
Curious if Medicare covers dermatology? We’ve also responded to that question: Does Medicare cover dermatology?
Original Medicare and Medicare Advantage plans cover medically necessary skin cancer biopsies to diagnose skin cancer. Medicare Part A would provide coverage if the biopsy is done as an inpatient. Part B covers outpatient biopsies. If there is medication or anesthesia administered by your doctor during the biopsy, those are traditionally covered by your Medicare Part D prescription drug plan or Medicare Advantage Prescription Drug plan.
With all, you must meet your Part A, B, or D deductibles, and then there is a Part B 20% coinsurance for Medicare-approved amounts. Medicare Advantage plans provide the same coverage as Original Medicare, at minimum. You should check with your Medicare Advantage plan to determine the cost of any deductible, copayments, or coinsurance.
Yes, Original Medicare and Medicare Advantage plans cover medically necessary skin exams for cancer. For example, if your doctor notices an abnormal change in the color of a mole or a new skin growth, a cancer screening would be covered by Medicare. Deductibles, coinsurance, and copayments may apply.
Maybe. Original Medicare doesn’t cover plastic surgery unless it is medically necessary. For example, Medicare covers breast prostheses for breast reconstruction if you have a mastectomy because of breast cancer. If you would like plastic surgery after skin cancer, you would require prior authorization before Medicare will pay for it. If Medicare approves the request, then you would pay the deductible and any coinsurance or copayments.
If you have a Medicare Advantage plan, you should check your “Summary of Benefits” to see what is covered. Oftentimes, Medicare Advantage plans provide greater coverage than Original Medicare.
Read more by Renee van Staveren