Does Medicaid Cover Dermatology?
- Find out when Medicaid is likely to cover dermatology so you can make an informed decision about care. Learn about copays, referral requirements and more.
Skin problems are one of the most common reasons why people seek medical care in the United States. Family doctors can successfully diagnose and treat some skin disorders, but often, a referral is needed to see a dermatologist. Dermatology is a medical specialty focused on the care of skin.
According to the National Center for Health Statistics, tens of millions of Americans receive care from dermatologists each year, and Medicaid may cover some of these services for eligible enrollees.
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Does Medicaid Cover Dermatology?
Medicaid is partially funded by the federal government, but it's up to the states to establish coverage guidelines. As a result, whether Medicaid covers dermatology depends on where you live. Your state's Medicaid guidelines may exclude dermatology services entirely or only cover treatment for specific conditions.
If your state does offer coverage for dermatology, you'll usually need to get a referral from your primary care physician before scheduling an appointment with a dermatologist. Without a referral, Medicaid is unlikely to cover the cost of your appointment.
Does Medicaid Cover Specialists?
The federal government mandates that all state Medicaid programs include coverage for physician services, including specialists. States may:
- Place restrictions on the number of times you can see a physician during a certain period, such as one month or one year or more frequently with prior authorization
- Exclude coverage for certain treatments or procedures
- Require you to pay a copay every time you see a specialist
Your state's Medicaid guidelines provide detailed information about coverage for specialists.
What Treatments Are Covered by Medicaid?
Medicaid coverage for dermatology treatment varies by state. Some conditions that dermatologists treat include acne, skin cancer, port-wine stains, psoriasis, eczema and some signs of aging.
The American Academy of Dermatology (AAD) reports that acne is the most common skin condition in the United States. Acne occurs when the openings in the skin called the pores become blocked, leading to inflammation and the appearance of blemishes.
Acne is usually controlled with topical and oral medications. Doctors must typically attest to the fact that acne medications are medically necessary and not simply cosmetic in nature for Medicaid to provide coverage for the care of a dermatologist.
Skin cancer is the most commonly diagnosed form of cancer in the United States, according to the U.S. Centers for Disease Control and Prevention. Skin cancer can develop when skin cells begin to grow abnormally. Some forms of skin cancer are related to exposure to ultraviolet light from natural sunlight and tanning beds.
Skin cancer screenings are often covered by Medicaid under preventative services, and improvements to the program put in place by the Affordable Care Act allow many recipients to qualify for coverage for skin cancer treatment.
A port-wine stain is a large birthmark that is reddish-purple. Laser treatments can reduce the prominence of port-wine stains by reducing the size of blood vessels in the affected area. In some states, port-wine stain removal is a mandatory benefit that Medicaid must cover.
Psoriasis is a chronic skin condition that affects roughly 7.5 million people in the United States, according to the AAD. Individuals with psoriasis develop red, scaly skin patches that may itch and burn.
Because no cure for psoriasis exists, dermatologists focus on managing the disease to reduce the frequency of outbreaks. Moisturizers, light therapy and topical, oral and injectable medications may be prescribed as treatment. Medicaid usually covers at least some psoriasis treatment.
The AAD states that 1 out of every 10 Individuals develops atopic dermatitis or eczema at some point in their lives. The condition is marked by extremely dry skin that becomes sore or itchy. Topical, oral and injectable medications may be used to ease symptoms and reduce the frequency of outbreaks. Medicaid will often cover at least some of these treatments.
Signs of Aging
Dermatologists perform a variety of services to diminish signs of aging, such as chemical peels and Botox. Because these procedures are considered cosmetic, they're unlikely to be covered by Medicaid.
Do All Dermatologists Accept Medicaid?
Unfortunately, not all dermatologists accept Medicaid. Generally, Medicaid programs pay a smaller percentage of reimbursement costs than private insurance, making it economically unfeasible for dermatologists to treat Medicaid recipients.
Dermatologists whose primary focus is cosmetic procedures may not accept Medicaid because the program is unlikely to cover their services.
How Can I Find a Dermatologist in My Area?
Each state's Medicaid program has a tool that lets you search for doctors by area. You can consult your state's Medicaid website to start your search.