Mole removal is one of the many common services offered by dermatologists. Dermatology is the field of medicine that addresses the skin and its diseases, infections, and imperfections. The cost of mole removal may be covered by Medicare insurance, but a few conditions must be met to qualify for coverage.
Dermatology serves to examine, analyze, and treat all conditions relating to the skin, nails, hair, or other body membranes. Skin serves as the primary line of defense for our bodies, and it must withstand a variety of different bacteria and stand up to trauma to maintain your health. These potential issues can lead to the development of skin disease or other imperfections.
Many of the procedures performed by dermatologists are considered cosmetic. Cosmetic procedures are generally related to visual appearance. Some examples of cosmetic treatments include elective Botox injections, scar or wrinkle reduction, laser tattoo removal, hair restoration, varicose vein treatments, and more. Mole removal also falls under this category in most cases.
Medicare Coverage for Mole Removal
In order for Medicare insurance to cover mole removal, the procedure must be deemed medically necessary by your healthcare provider. If you are trying to get a mole removed simply because of its visual appearance or location, Medicare coverage will most likely not pay for the procedure.
However, Medicare will provide coverage if any of the following conditions is met. If the mole has been susceptible to bleeding, intense itching, rapid growing, or pain, examining the mole could be necessary to ensure no further health issues stem from it. Also, if the mole has shown signs of inflammation and is swelling or oozing, removing it could be beneficial in preventing an infection from developing and spreading.
Mole removal will also be covered if the mole is obstructing your vision, makes breathing through your nose or mouth difficult, or affects any of your other senses or daily functions. The same is true for moles that look like they could be malignant or cancerous.
Costs Under Medicare
If you have consulted with your doctor and determined that your treatment will be covered by Medicare, the cost you will be responsible for is dependent on your specific Medicare coverage.
If you have Original Medicare, you will need to cover 20 percent of the Medicare-approved amount of the services as long as your medical provider accepts assignment. This is the amount that Medicare has agreed to pay for that specific service. If the treatment cost is higher than that amount, you will be required to cover the difference in cost as well.
The other 80 percent of the Medicare-approved amount will be covered by Medicare Part B, which covers doctor’s services and supplies needed to diagnose and treat a variety of illnesses and conditions. The Part B deductible will apply.
If you have a Medicare Advantage plan, you will receive the same benefits as an individual using Original Medicare. However, Medicare Advantage plans are offered by private insurance companies approved by Medicare. These plans can have different copayments based on the specific service.
If your dermatologist prescribes any medications for you to use following your mole removal, you may be covered by Medicare if you have a Part D plan. Prescription drug plans plans cover prescription medications. Each drug plan has its own formulary, or list of covered drugs, and tiers of pricing.