Does Medicare Cover Dermatologists?

Christian Worstell
In this article...
  • Learn about Medicare's coverage rules for outpatient dermatology services and how to determine if you're eligible for coverage through a standalone Medicare plan.

Medicare is designed to protect older and disabled adults from financial hardship due to the need for medical services. Whether inpatient or outpatient services are provided, Medicare has strict rules governing coverage.

Namely, covered services must be provided for legitimate medical conditions and not simply for cosmetic purposes. That being said, does Medicare cover dermatologists? The answer is, it depends. 

Learn what Medicare does and does not cover when it comes to dermatology services. 

Does Medicare Cover Dermatologists? 

Dermatology can be covered by Medicare if your doctor determines it's medically necessary. Medicare doesn't typically cover dermatology if it's only for cosmetic purposes.

The problem some individuals have is determining what is medically necessary versus cosmetic.

This is a conversation that should happen with a primary care physician (PCP) or general practitioner prior to scheduling an appointment. Your PCP can help you determine if seeing a dermatologist is medically necessary. 

Does Medicare Pay for Visits to the Dermatologist? 

The portion of Medicare that covers outpatient services, also known as Part B, provides coverage to recipients who see a dermatologist in an outpatient setting provided the reason for the visit establishes medical necessity.

To be covered for a dermatology visit, a beneficiary needs to opt in to Part B and be current with their premium payments. Medicare recipients enrolled in a Part C, or Medicare Advantage, plan need to review their coverage documents to confirm the plan rules about dermatology services. 

Is Routine Dermatology Covered by Medicare? 

In most cases, routine dermatology services are not covered by Medicare. The exception may be an individual with Part B coverage who needs to see a dermatologist for the evaluation, diagnosis, treatment or management of a medical condition. This would be considered a problem-focused visit and not routine.

Additionally, some Medicare Advantage plans may offer coverage for dermatology that expands beyond traditional Medicare limits. 

Do I Have a Copayment to See a Dermatologist? 

Assuming the reason for your visit involves meeting criteria for medical necessity, you may be responsible for a cost-share (usually 20% for Part B recipients) or copayment (if enrolled in a Medicare Advantage plan).

Some plans have a deductible as well, which will need to be met before the plan will pay its share. Referrals for outpatient dermatology services are required if you are enrolled in a plan that requires referrals to see specialists.

You can compare Medicare Advantage plan benefits and costs online, or you can call a licensed insurance agent to get help comparing plans that are available where you live.

Christian Worstell
About the Author

Christian Worstell is a senior Medicare and health insurance writer with HelpAdivsor.com. He is also a licensed health insurance agent. Christian is well-known in the insurance industry for the thousands of educational articles he’s written, helping Americans better understand their health insurance and Medicare coverage.

Christian’s work as a Medicare expert has appeared in several top-tier and trade news outlets including Forbes, MarketWatch, WebMD and Yahoo! Finance.

While at HelpAdvisor, Christian has written hundreds of articles that teach Medicare beneficiaries the best practices for navigating Medicare. His articles are read by thousands of older Americans each month. By better understanding their health care coverage, readers may hopefully learn how to limit their out-of-pocket Medicare spending and access quality medical care.

Christian’s passion for his role stems from his desire to make a difference in the senior community. He strongly believes that the more beneficiaries know about their Medicare coverage, the better their overall health and wellness is as a result.

A current resident of Raleigh, Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism. You can find Christian’s most recent articles in our blog.

If you’re a member of the media looking to connect with Christian, please don’t hesitate to email our public relations team at Mike@MyHelpAdvisor.com.

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