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Many skin conditions, including dangerous symptoms of skin cancer, are a common problem for seniors.
Medicare may cover some dermatology services as long as they are deemed medically necessary by your doctor.
Not all skin-related concerns are covered under Original Medicare. If you require additional coverage, you may be better off enrolling in a Medicare Advantage plan.
Medicare Advantage plans, also known as Medicare Part C plans, are required by law to offer the same level of coverage as Original Medicare, but they often carry additional benefits well beyond what Original Medicare Parts A and B can provide.
Did you know that each year in the U.S., more than 5 million people are treated for skin cancer? In most cases, these treatments are given to adults aged 65 and older, but still, less than half of older adults have a good understanding of how to protect their skin.
Thankfully, there is an entire medical field dedicated to the medical treatment of skin conditions and diseases. Experts in this field are called dermatologists. Dermatologists are specialists who regularly treat disorders of the skin, hair, nails, and adjacent mucous membranes.
As a result of their specialist status, financial reimbursement and payment for their services can fall into a variety of Medicare coverage rules. Let’s take a closer look in an attempt to answer the question: “does Medicare cover dermatology?”
Original Medicare Parts A and B are often extremely helpful for seniors who require coverage for the most basic levels of care, but when it comes to specialized fields like dermatology, things can get a little tricky.
Basically, for Original Medicare to cover the cost of dermatology services, your treatment must be considered medically necessary in the eyes of your doctor or healthcare provider. Furthermore, any treatment you do receive must be administered as a result of a specific, professionally diagnosed medical condition.
Exactly what is covered by your Original Medicare plan depends on what dermatology services you are attempting to receive.
Keeping in mind that any dermatology treatment you receive must be considered medically necessary and used to treat a specific, diagnosed medical condition, the following dermatology services are usually covered under Original Medicare Part B:
Please note that even if your dermatology services are covered by Original Medicare, you will likely be required to pay some out-of-pocket costs for your dermatology appointments in the form of copayments and coinsurance. Usually, these payments can range anywhere from 10 to 20 percent if you only have Original Medicare coverage. Other expenses may include your Medicare Part D deductible (which is $233 for 2022).
While Original Medicare often covers services designed to treat skin-related medical conditions, it does not usually cover dermatology treatments and services that are considered to be cosmetic in nature. Examples of dermatology services that are not covered by Original Medicare Parts A and B include:
If you are unsure about exactly what services will be covered by your Original Medicare plan, the best thing to do is ask your dermatologist ahead of time if he or she accepts Medicare assignment. If not, you may be required to pay an excess charge beyond your coinsurance payment up to an additional 15 percent.
Original Medicare can be a great resource for basic coverage of many common senior healthcare services, but it isn’t the be-all, end-all when it comes to comprehensive health insurance plans.
Luckily, there is another option, known as Medicare Advantage (or Medicare Part C) that can often provide additional benefits beyond what is covered by Original Medicare Parts A and B. In the world of dermatology, this may include some cosmetic treatments on skin-care medications, but this will depend on the specific Medicare Advantage plan you decide to enroll in.
While Medicare Advantage plans are required by law to cover the same treatments and services as Original Medicare, they can also carry additional coverage benefits that can vary from plan to plan. Typically, however, Medicare Advantage will offer additional coverage for needs pertaining to vision care, hearing care, and dental care that are not covered under Traditional Medicare.
Keep in mind that Medicare Advantage plans are offered by private insurance companies, and therefore their exact pricing, availability, and specific coverage benefits are not always the same across the board.
If you are interested in learning more about your possible Medicare Advantage options today, the licensed insurance agents at MedicareInsurance.com are here to help. Simply give us a call at (800) 950-0608 today to start exploring and comparing your health insurance options under Medicare.