Does Medicare Cover Mole Removal? 

Everyone wants to have healthy clear skin, but in reality, no one has perfect skin. Freckles, blemishes, wrinkles – all of these features can affect the way skin looks and feels. For the most part, these features are benign. Moles, however, can be a sign of a more serious condition like skin cancer. Seniors are encouraged to check for new moles on a regular basis. Most moles are benign, but if a mole changes color, has irregular borders or is painful or bleeding, you’re encouraged to talk to your doctor.

What causes moles?

Everyone’s skin contains a pigmented substance called melanin. This is partially what determines how light or dark someone’s skin becomes as the body develops. Melanocytes are clusters of melanin, and these melanocytes make up the basis of mole growth. In most cases, melanin is distributed throughout the skin to give it an even tone. When clusters of melanin form, mole growth occurs. This not only causes the dark appearance of moles, but the cluster of cells can also give the area a raised and bumpy appearance.

How are moles treated?

As stated above, most moles are natural and require no treatment unless they are a cosmetic problem. If your doctor believes that a mole may be indicative of cancer or some other serious skin condition, mole removal surgery may be an option. This type of surgery is generally performed in an outpatient setting by a dermatologist. A suspicious mole can be surgically excised using hand tools, but laser removal may be another option. In addition, a technique known as shaving excision may be used to remove a suspicious mole in layers by shaving it down.

Does Medicare cover mole removal?

Original Medicare covers skin care only in cases where treatments are considered medically necessary. Medicare benefits will cover mole removal surgery only if your doctor is concerned about a mole affecting your health. Seniors who are concerned about moles for cosmetic reasons are not able to use Medicare benefits for mole removal.

Original Medicare insurance does not cover cosmetic procedures of any kind when the sole intent of the medical treatment is to enhance appearance. If your appearance is improved after having a mole removed as a medical necessity, Medicare benefits will still cover the procedure as long as the main purpose of the procedure is to protect your health.

Outpatient mole removal coverage

In the vast majority of cases, mole removal is handled on an outpatient basis. Most procedures can be performed using local anesthetic and medical tools in a dermatologist’s office. These visits and procedures are covered by Medicare Part B, the outpatient portion of Medicare benefits. Under Part B, Medicare recipients pay 20% of the total cost of services provided while Medicare covers 80%.

In order to use your Medicare insurance coverage for outpatient procedures, you will need to be current on your premium and meet your plan’s deductible. The standard Medicare Part B deductible varies from year to year, but for 2023, it is $226. The dermatologist performing your mole removal surgery will also need to be a Medicare-participating provider.

Inpatient mole removal coverage

If you happen to require mole removal surgery while admitted to a hospital, your surgery will be covered by Medicare Part A instead. Medicare benefits under Part A supply inpatient coverage for admissions to Medicare-participating hospitals and skilled nursing facilities. Medicare recipients are only provided with a limited number of days to use for inpatient care each benefit period.

Hospital coverage is limited to 60 days at full coverage, and admission to a skilled nursing facility allows for up to 20 days at full coverage. Beyond these restrictions, additional days are available at a per-day cost up to 90 days in a hospital and 100 days in a skilled nursing facility. Like Medicare Part B, Medicare Part A also requires that you meet a deductible in order to use your Medicare benefits; however, unlike Part B, most Medicare recipients receive Part A coverage with no premium required.

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