Does Medicare Cover Dermatology? 

Your skin is not only your largest organ, but it also serves as one of the primary pathways through which germs and toxins can enter the body. Thankfully, healthy skin serves as a barrier to prevent infections and other medical threats, but unhealthy skin can allow contaminants to enter the body and cause serious harm.

As a result, taking care of your skin is of the utmost importance at any age, but it becomes particularly important as you grow older. The body’s skin changes over time, becoming thinner and looser in your senior years. This is the result of a breakdown in collagen and collagen production, factors that give skin elasticity and vitality.

Seeking dermatological care

Aside from the natural decline in skin health with age, there are a number of skin conditions that can also affect the look and feel of the skin. Everything from rashes and irritation to cuts and scrapes can cause problems with skin, and many skin conditions require treatment by a dermatologist.

This is a medical specialist who works with skin health issues. A dermatologist may work in concert with a primary care physician, an internist, an oncologist or a wound care specialist to assist people who have experienced damage to the skin, who have experienced skin cancer or who have undergone medical treatments that have affected the skin. These medical professionals often provide visual examination, pathology and biopsy services and topical treatment for skin diseases.

Does Medicare cover dermatology?

Original Medicare may cover dermatology care in some instances. The key to all Medicare coverage is that treatment must be considered medically necessary in order to qualify for coverage. This means that dermatological services that are obtained purely for cosmetic reasons are not covered. Medicare considers cosmetic procedures to be lifestyle concerns, and as such, these treatments are not covered.

If Medicare covers your dermatology treatment, it will do so under one or more of the various parts of the program. For outpatient care, Medicare benefits are provided by Part B. This part of Original Medicare supplies coverage for the treatment of skin conditions as well as diagnostic and lab testing. This is also the part of Medicare benefits that covers in-office visits with specialists.

Medicare Part A coverage for dermatology services

Medicare benefits for inpatient dermatology care are supplied by Part A. This coverage is available to assist with costs if you are hospitalized or you receive care in a skilled nursing facility. If a dermatologist is brought in from outside of the treatment facility’s staff, billing may occur under Medicare Part B for those specific services.

Medicare Part D coverage for dermatology services

If your skin condition requires prescription medications to resolve, Medicare Part D, the prescription drug benefit, may supply coverage. The important thing to note about Medicare benefits under Part D is that only medications included in your plan’s formulary are considered for coverage. Additionally, you will need to be able to purchase your prescriptions from a retail pharmacy for home use in order for Medicare Part D to supply coverage. Medications administered in a hospital or skilled nursing facility would be covered under Medicare Part A, and medications administered in a dermatologist’s office would be covered under Medicare Part B.

Does Medicare Advantage cover dermatology?

Medicare Advantage plans typically cover dermatological services in the same way as Original Medicare benefits. This is because Medicare Advantage plans are required to provide the same level of coverage as Original Medicare. The difference, however, is that Medicare Advantage plan providers have more flexibility in the benefits they can offer on top of those included in Original Medicare coverage. Because each plan is different and different states have differing regulations, you’re encouraged to speak with a Medicare plan advisor to learn your options.

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