Are Dermatology Services Covered by Health Insurance?

Medicare Benefits Solutions
Jan 31, 2022

Believe it or not, your skin is your body’s largest organ. While the skin may not seem as complex as your brain or liver, the skin is actually teeming with activity 24 hours a day. Whether it is protecting your insides from harmful organisms or it is replenishing and rejuvenating its cells, your skin is always active and alive.

Unfortunately, all of this activity also means that your skin deals with a lot of hazards. Bacteria, abnormal cell growth, inflammation and more can all lead to skin conditions that may cause unsightly warts, blemishes, moles, and rashes as well as skin cancer. This also means that damaged skin can potentially lead to infection. 

Read on to discover: “Does insurance cover dermatology?”

For many people, dealing with these types of problems only requires the use of over-the-counter topical treatments and general wellness care. For others, however, the services of a dermatologist are needed to treat skin diseases and chronic skin conditions. This may have you wondering if dermatology is covered by insurance and what does Medicare cover for dermatology visits.

What is a Dermatologist?

A dermatologist is a medical professional who specializes in skincare. Dermatology concerns itself with how the skin functions relative to the rest of the body in supporting overall health. Because the skin serves as a protective barrier for the entire body, dermatology professionals will need to have an understanding of various functions of the body as they relate to microorganisms that may affect the body through the skin.

Is Dermatology a Cosmetic Profession?

It’s important to draw a distinction between dermatology and cosmetic professions like esthetician services. An esthetician is someone who works with skin, but an esthetician typically focuses on the cosmetic aspect of the skin. 

A dermatologist is a licensed medical doctor who specializes in the medical health of skin and its function relative to overall health. A dermatologist will also have training in surgical procedures involving the skin whereas an esthetician will not be licensed to perform surgical procedures.

How Does Medicare Cover Dermatology Benefits?

Caring for your skin in your 60s, 70s and beyond is important for overall health and wellness. Skin health is important at any age, so even seniors can be affected by skin health concerns. Additionally, skin changes with age, so dermatological treatment may require specialized care, such as wart or mole removal as you get older. For these reasons, Medicare generally covers dermatology care through Medicare Part B.

Medicare Part B is the outpatient benefit of Medicare. It provides coverage for doctor visits, specialist visits, surgery, clinical care and more. Under most Part B plans, costs are split between the patient and the provider. Medicare usually covers 80% of dermatology costs while the Medicare recipient covers the remaining 20%.

Medicare may cover some prescription medications associated with dermatological care under Part D, the prescription drug benefit. This is an optional coverage, and in order for a medication to be covered, the medication must be listed under the plan’s formulary. Additionally, the medication will need to be available for purchase from a retail pharmacy for administration at home. Medications administered in a dermatologist’s office will fall under coverage supplied by Medicare Part B, and medications administered while admitted to a hospital would be covered by Medicare Part A.

Are Dermatology Services Covered by Medicare or Other Insurance?

In order for a dermatological service to qualify for Medicare coverage, the service must be medically necessary. This means that services administered for purely cosmetic purposes typically do not qualify for coverage. Services provided by an esthetician or similar professional are not covered.

With this stated, it should be noted that services may still be covered by Medicare even if a cosmetic benefit is obtained. This means that treatment for a skin rash might benefit your appearance, but as long as the treatment is provided to keep the rash from affecting your overall health, the treatment would be covered even though you gained a cosmetic benefit from it.