As we age, our skin changes in a lot of ways. It grows thinner and becomes more prone to blemishes, such as age spots. We develop wrinkles and discover our skin doesn’t heal as quickly. Unfortunately, our skin also becomes more susceptible to various infections, lesions, and even cancers. Dermatologists specialize in medicine related to skin. If you have a problem with your skin, you might wonder if Medicare benefits will cover a dermatology appointment.
Cosmetic vs. Medically Necessary
Before you schedule any appointments with a dermatologist, you should always start with a visit to your primary care physician. Your regular physician will generally determine whether or not a skin problem requires a consultation with a dermatologist. One of the main criteria that they’ll use in making that determination is medical necessity.
Medical necessity is a fancy way of saying you need a kind of treatment or access to a specialist in order to preserve your life or because of a pressing medical need. Many skin problems that people dislike are not threats to life or health, they’re simply visually unappealing. Age spots and wrinkles, for example, typically fall into that category. They are cosmetic problems and any medical procedures related to them are cosmetic procedures.
Medicare typically covers medically necessary treatments, procedures, and appointments. As a rule, it provides little to no coverage for purely cosmetic treatment.
Dermatology Covered by Medicare
Among other things, dermatologists can help identify skin cancers. If you go to your doctor because a mole changes size, color or shape, they might refer you to a dermatologist for testing. Your doctor might also refer to you to a dermatologist if you presented with a skin infection that didn’t respond to standard treatments.
These are cases where treatment relates directly to your health. Preserving your health or life is the purpose of the dermatology consultation. Since your doctor deemed it medically necessary, Medicare would likely consider them qualified under your standard Medicare benefits. If you’re concerned about coverage, you can always ask your doctor about the likelihood that the appointment won’t be covered. As a rule, though, doctors who regularly treat Medicare patients refer them for treatments that Medicare covers.
Costs of Dermatology
The costs involved with dermatology consultations and treatments can vary. Assuming your doctor deems the visit medically necessary and Medicare concurs, the standard cost for you is 20% of the Medicare-approved price. In some cases, the dermatologist might charge more than the Medicare-approved price. In those situations, Medicare only pays their portion of their approved pricing. You would generally be responsible for the difference.
You can avoid this situation by asking for a referral to a dermatologist that accepts assignment. The term assignment, in this context, means that the doctor waives whatever fee they typically charge and accept the Medicare pricing for Medicare patients.
Medicare coverage can extend to dermatology, but it depends on the situation. If your doctor deems it medically necessary for you to see a dermatologist, Medicare will usually provide coverage.