Medicare may cover your visit to the dermatologist’s office, but it depends upon the reason and circumstances of your visit. If you have a Medicare Advantage or Medicare Supplement plan, that may also affect coverage.
Dermatologists are specialists who deal with skin and skin diseases and treat disorders of the skin, hair, nails, and adjacent mucous membranes.1
One of the most critical things dermatologists do is screen for and treat skin cancer. In recent years, the incidence of skin cancer among older patients has increased dramatically, although that may be a result of more and better screening.2
Because dermatologists are specialists, reimbursement for their services can fall under a variety of different Medicare rules. Here’s a closer look at Medicare dermatology coverage.
Medically Necessary Treatments
For Medicare to cover the cost, your dermatology office visit and treatment must be deemed medically necessary. Also, it must evaluate, diagnose, or treat a specific medical condition. Medicare, for example, covers the treatment of skin cancer or chronic skin conditions. With some Medicare Advantage networks, you’ll need a referral from your primary care physician before seeing a dermatologist. Some Medicare Advantage plans also require prior authorization, which means the insurer must review and approve the dermatologist’s plan.
Like most Medicare doctor visits, you’ll pay some out-of-pocket costs for dermatologist appointments. Those expenses include your deductible ($198 in 2020) and a 20% coinsurance payment if you only have Original Medicare.3 Some Medicare Supplement plans, also called Medigap, can help cover out-of-pocket costs for dermatology.
Is Your Doctor “Accepting Assignment?”
Ask your dermatologist if he or she accepts Medicare reimbursement as payment in full, often called “accepting assignment.” If not, you may pay an excess charge beyond your coinsurance up to an additional 15%.4 A Medicare Supplement plan can help cover these costs.
A Medicare Advantage plan can have a deductible and will likely charge a copayment for the visits. You will likely need to see doctors in network and Medicare Advantage plans often require prior approval.
Non-medically necessary treatments
Medicare does not cover treatment for non-medically necessary and cosmetic conditions such as non-cancerous acne or anti-aging skin treatments.
Cancer screenings done by a dermatologist are not covered if they are part of a routine dermatology exam and you show no signs of skin cancer. They are covered, however, if you or your primary care doctor has noticed a sign of skin cancer (such as a mole that has changed color or new skin growth) or if you or your family has a significant history of cancer.
To determine if Medicare covers the care you seek, always ask your primary care physician and dermatologist about Medicare coverage before starting treatment. If you have a Medicare Advantage plan, contact your insurer directly to find out what’s covered. Medicare Advantage plans may cover dermatology treatment beyond the government medically-necessary Medicare guidelines.