Part of the aging process involves skin concerns — from cosmetic to cancer and various spots, bumps and wrinkles in between. For those on Medicare, it can be challenging to figure out what parts of Dermatology are covered and which aren’t. The team at Blue Cross and Blue Shield of Kansas did some digging to answer the most frequently asked questions about Medicare coverage for dermatology. 

Does Medicare cover dermatology?

Medicare covers various skin conditions and concerns, but there’s generally a firm line drawn in the sand by the majority of Medicare plans: 

• Medically Necessary: If a skin condition poses a health threat or shows signs of a potentially serious skin condition, Medicare will cover most issues. 
• Cosmetic: If a skin condition is an aesthetic concern, like wrinkles or unsightly skin spots that pose no threat, it’s likely not going to be covered. 

Medicare recipients might not always know the difference between the two because some skin issues come with aesthetic concerns and medical risks. Blue Cross and Blue Shield of Kansas representatives can walk you through the different plans and parts to get the best overall dermatology coverage for your specific needs. 

• Laser/Ultraviolent Light Treatments: Skin conditions like psoriasis and eczema can benefit from the use of laser therapy, and it’s covered by most Medicare plans. Laser therapy for hair removal is considered cosmetic and is not covered under any part of Medicare plans. 
• Topical Creams: Medicare Part D covers prescription medication, including creams or gels required for a medically necessary skin issue. 
• Vaccinations: The Inflation Reduction Act in 2022 brought some big changes to medicare for 2023, including no out-of-pocket cost for Medicare recipients to get the shingles vaccine. 

MORE INFORMATION: Read the full list of changes and cost-savings from the Inflation Reduction Act.

Does Medicare require a referral for a dermatologist?

If you are new to Medicare, make sure you discuss any skin condition concerns during your “Welcome to Medicare” preventative visit. 

Referrals are required under some plans, but it’s important to know what kind of plan you have before booking an appointment with a dermatologist. 

• Original Medicare: You likely won’t need a referral to see a specialist
• Medicare Advantage: You might need a referral to see a specialist. Check with your Blue Cross and Blue Shield of Kansas representative.

Medicare recipients also need to confirm the dermatologist accepts Medicare and the responsibility is on the patient to check this before the appointment. You can also search the Blue Cross and Blue Shield of Kansas website for a list of Medicare-participating doctors in the state. 

Does Medicare cover dermatology cancer screening?

Most Medicare plans will cover dermatology cancer screenings, but there’s a pretty big deciding factor – specific skin changes. A general skin check without any cause for concern isn’t going to be covered. You can bring up skin cancer concerns, like having spent a lot of time in the sun when you were younger, at your annual wellness visit. 

Does Medicare cover skin cancer treatment?

If you do have skin cancer, Medicare Part A, Part B and Advantage plans cover most medically required treatments.

There are three main types of skin cancer: 

• Basal cell carcinoma: This is the most common type of skin cancer. Early diagnosis is important to avoid serious problems down the road. 
• Squamous cell carcinoma: You’ll find these in the areas of the body that have seen extended exposure to the sun, like the face, neck, and arms. Early detection can prevent the spread to other parts of the body. 
• Melanoma: The most dangerous skin cancer. It spreads rapidly and can develop in a mole previously deemed safe. 

If you have skin cancer and need to be hospitalized for treatments, that’s covered under Medicare Part A. Medicare Part B will cover outpatient services for treatment. Medicare Advantage plans will cover both, with additional Part D prescription services as needed. 

FACT: The average age for a melanoma diagnosis is 65 in the United States.

Does Medicare cover a full body skin exam?

Of all the preventative treatments that Medicare covers, an asymptotic body scan for moles and other cancerous growths aren’t included as of 2023. 

This is why it’s important to do a skin cancer screening of your own at home. Have a loved one help you do a full body scan for any moles that have changed in size or color or any new moles that have developed. If you notice even the slightest change, Medicare Part B covers a visit to have the mole reviewed by a specialist. 

Does Medicare cover mole removal?

Sometimes moles change in color or size in a way that isn’t related to cancer, but it’s hard for the untrained eye to notice that. Once a doctor or specialist has determined there is a cancerous spot on a patient’s skin, Medicare will cover the removal of the spot through surgery, cryotherapy, or laser removal. 

Does Medicare cover acne treatment?

Acne is generally considered a cosmetic concern. There is no imminent health risk from having acne and since treating it would be for aesthetic reasons only, you likely won’t get coverage under any plan for in-office treatments for acne.

You should look at the formulary from Medicare Part D to see if any popular acne medications, like Accutane, are covered. Most plans will have some type of acne medication on the list. 

Does Medicare cover laser treatment for Rosacea?

Rosacea might seem like a cosmetic issue due to the bright red skin that can manifest with bumps and visible veins. The good news for Medicare patients is that rosacea is actually a medical diagnosis, which puts them in a category more likely to be treated with topical ointments or FDA-approved laser treatments.

Make sure to note how rosacea is impacting your eyes, nose, or mouth and if there are other limiting factors associated with it. While you can take steps to reduce a rosacea outbreak, it can only be treated. There is no cure. 

Does Medicare cover skin tag removal?

Skin tags are small pieces of excess skin that can grow anywhere on the body but are commonly found on the face, neck, armpits and groin. A skin tag does not pose an ongoing health risk and is generally a cosmetic concern. In most cases, removal wouldn’t be covered. 

Now, if a skin tag is excessively painful or itching, bleeds often, partially blocks vision, or has any other non-cosmetic health issues, there’s a good chance the removal would be covered under most medical plans. It’s important to bring a list of medical concerns with the skin tags and pictures of any abnormalities you’ve seen at home. 

Does Medicare cover Milia removal?

Milia are small white bumps that appear alone or in clusters on the skin. A common place to find milia is on the face. Once again, if the removal or treatment would be purely for cosmetic reasons, it’s won’t be covered. You will need to present reasons why it would be medically necessary to remove milia, such as intense pain, itches, changes in appearance, or blocking an orifice. 

Does Medicare cover Seborrheic Keratosis removal?

Seborrheic keratoses are also known as barnacles and they can be really concerning to the plain eye. They have several symptoms of cancer lesions, like changes in color, size and symmetry. One differentiator is that seborrheic keratoses look “stuck on” instead of growing from deep in the skin.

THE MORE YOU KNOW: Seborrheic Keratosis (SK) and Actinic Keratosis (AK) can have similar appearances, with scaly lesions and rapid changes, but it’s important to know the difference. Actinic keratosis CAN turn into skin cancer, while seborrheic keratosis will not. 

While you should bring any changing skin lesion to the attention of your doctor, it’s unlikely Medicare will cover barnacles unless they present an infection, bleeding, or pain. The older we get, the more of these lesions will grow, but never dismiss a new skin growth without talking to a doctor. 

Does Medicare cover shingles vaccine?

One of the benefits changing in 2023 includes the shingles vaccine being one of several new vaccines available under Medicare Part D with no out-of-pocket cost. Previously this Centers for Disease Control and Prevention vaccine recommendation was available for around $200. 

Conclusion

As much as it’s important to check blood pressure and heart rates, it’s important to check your skin. Don’t write off a cosmetic skin concern because you assume it’s not medically necessary to get treatment under Medicare. Write down any pain, itching, bleeding, or infection associated with skin issues. Have a trusted loved one help you evaluate your skin issues. 

The team at Blue Cross and Blue Shield of Kansas is fully prepared to explain the dermatological coverage questions and explain all the new benefits coming to you in 2023 due to the Inflation Reduction Act. Don’t miss the cost savings. Schedule an appointment with us now.