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November 10, 2021
In order for dermatology to be covered by Original Medicare, it must be deemed medically necessary by your primary care physician. In most cases, this means that said dermatology care is linked to a specific medical condition. Conversely, routine dermatology care and cosmetic procedures won’t be covered by Medicare.
If you have a Medicare Advantage plan, you might have additional dermatology coverage that goes beyond that of Original Medicare; however, this coverage will vary from plan to plan, so you’ll want to check with your provider.
If your doctor deems that dermatology services are medically necessary for the evaluation, diagnosis, or treatment of a specific medical condition, then Medicare will cover them. For example, Medicare will cover screenings and treatment related to skin cancer. With that said, you’ll likely need to pay your deductible and a percentage of the Medicare-approved amount.
Additionally, not all doctors accept Medicare, so you’ll want to be sure that the dermatologist referred by your doctor accepts Medicare.
FYI: While Medicare will cover the cost of a skin cancer screening ordered by your doctor, it will not cover this type of screening if it’s part of a routine dermatology exam.
Depending upon your provider, Medicare Advantage (Part C) may cover additional dermatology procedures such as routine checkups and medications. If these benefits are of particular interest to you, then you should check with your provider upon enrolling. In some cases, you might not even need a referral from your doctor to be eligible for Medicare Advantage dermatology coverage.
While Medicare coverage of dermatology will require you to meet your deductible and pay coinsurance, a Medigap plan can help you cover these costs. To learn more about these options, read my guide to this year’s best Medigap plans.
Did You Know: New to the world of Medicare supplemental insurance? Then you should read my guide: What Is Medigap?
If your dermatologist diagnoses you with a skin condition or disease, then you might have to pay for related prescription medication out of pocket. To cover these costs, you could look into a Medicare prescription drug coverage plan, that is, Medicare Part D.
Always remember that not every dermatologist accepts Medicare. In my experience, most primary care doctors will have a list of recommended dermatologists who accept Medicare.
Alternatively, you can use Medicare.gov’s care compare tool. By entering your ZIP code and provider type, you’ll find a local list of dermatologists who work with Medicare. Similarly, Medicare Advantage providers usually offer a list of in-network dermatologists whom you can contact.
While Medicare will never pay for cosmetic or routine dermatology, it can pay some, if not all, of the costs of medically necessary dermatology. The key is making sure you get this confirmation from your primary care physician and that the referred dermatologist accepts Medicare.
To learn more about Medicare coverage, take a look at our series of guides:
Medicare will cover your visit to a dermatologist, provided your general practitioner has referred you.
Since Medicare will not cover routine care with dermatologists, you will need a referral in order to receive coverage.
Medicare will not cover routine full-body skin exams, but it will cover one in the event that your doctor has deemed such an exam is medically necessary to treat or diagnose a condition.
Medicare will not pay for cosmetic or other non-medically necessary procedures, screenings, and treatments such as adult acne treatment.
Without insurance, a skin biopsy will cost you between $120 and $400; however, there may be additional lab evaluation fees.
