Does Aetna Cover Dermatology?
- Dermatologists can diagnose and treat thousands of conditions. Learn what guidelines govern how Aetna covers dermatology services and what costs are involved.
If you're seeking care for a condition involving your skin, hair or nails, you may need to see a dermatologist. These specialists can diagnose and treat thousands of conditions, ranging from acne to skin cancer. The good news is that many health insurance plans cover dermatology services.
While Original Medicare (Medicare Part A and Part B) doesn't typically cover routine dermatology, some Medicare Advantage (Medicare Part C) plans – such as those offered by Aetna – may cover some dermatology services that Original Medicare doesn't. While Aetna Medicare plans typically don't cover routine dermatology, they may cover a dermatological exam as part of an annual health exam.
Compare Aetna Medicare Advantage plans available where you live to find out what types of dermatology services they may cover. Be sure to ask with your plan provider directly about whether an Aetna plan covers any dermatology services.
Does Aetna Cover Dermatology?
Aetna health plans, including Medicare Advantage through Aetna, cover most types of preventive, diagnostic and medically necessary care, including medically necessary dermatology services. This might include a dermatology exam with your doctor if you're concerned about potential skin cancer.
Because many dermatological treatments are used for both cosmetic and medically necessary care, individuals may have to meet specific clinical criteria prior to receiving approval for coverage. For example, skin tag removal may be covered if friction at the tag's location causes irritation and bleeding, but Medicare won't likely cover skin tag removal if it's purely for cosmetic purposes.
Depending on the individual policy, plan participants may also need to satisfy additional criteria, such as receiving care from an in-network dermatologist or getting a referral from their primary care physician, and any applicable deductibles typically must be met before coverage kicks in. Some plans may also limit the number of times certain screenings may be performed each year.
Does Aetna Require a Referral to See a Dermatologist?
Many Aetna HMO, EPO and PPO plans require a referral from a primary care physician before a participant may receive care from a specialist such as a dermatologist. However, other plans, such as the Aetna Open Choice PPO or the company's indemnity plans, permit members to see an in- or out-of-network specialist without a referral.
Does Aetna Have a Copay?
Participants in some Aetna plans, including many HMOs and PPOs, must pay copays or coinsurance when visiting a dermatologist. The amount of this payment can vary depending on the individual policy and the services received. Depending on your plan, you may pay higher out-of-pocket costs if you visit a provider outside of the Aetna provider network.
What Dermatology Services Aren’t Covered Through Aetna?
Aetna typically doesn't cover elective procedures done only for aesthetic purposes. For example, if a scar doesn't cause pain or impair an individual's ability to function, the cost of removal likely won't be covered by Aetna. Purely cosmetic procedures may include:
- Laser hair removal
- Eyebrow or eyelash tattooing
- Tattoo removal
- Pulsed light laser treatments to reduce facial redness
- Removal or reduction of frown lines
- Depigmentation laser treatments
Aetna coverage may also exclude treatments and procedures that aren’t yet widely accepted by the medical community.
Does Aetna Cover the Cost of Plastic Surgery?
Aetna doesn’t cover the cost of plastic surgery that’s done exclusively for cosmetic purposes. However, surgeries or procedures done to ease pain or improve a body part’s functioning may be covered, even if they alter the individual’s appearance.
Aetna may also cover the cost of plastic surgery if it’s prescribed to:
- Correct a disfigurement caused by surgery or a traumatic injury
- Correct a congenital defect such as a cleft palate
- Reconstruct breasts after a mastectomy
- Treat individuals with gender dysphoria
- Reduce breast size to control headaches, back pain or skin breakdown
Dermatologists seeking approval for these and other plastic surgery procedures may need to submit documentation substantiating medical necessity. Documentation may include photographs, diagnostic imaging, patient records and any relevant correspondence between the physicians involved. If Aetna denies coverage for a procedure, participants or their physicians may file an appeal.
Where Can You Find Information About Your Specific Plan's Coverage?
Because dermatology coverage can vary widely by plan type, it’s important to understand what your individual policy covers and any requirements that must be met. This information is included in your plan documents, which are typically provided when your healthcare coverage begins. These documents contain information on covered services, plan requirements and applicable out-of-pocket costs. If you haven’t received your plan documents, contact Aetna’s member services department to request a copy.
How Can I Find a Dermatologist Near Me?
If you need specialty care for a condition involving your skin, nails or hair, your primary care physician can typically recommend a dermatologist who accepts your insurance, or you can access a list of in-network providers directly through Aetna. You can find a reputable dermatologist through the American Academy of Dermatology's dermatologist locator tool. Searches may be performed using a zip code or city and state.
Who Can Answer Additional Coverage Questions?
If you're a current Aetna plan member and have questions about your Aetna coverage, you can reach out to their member services department at (800) 872-3862. Member services can provide information about:
- Specific benefits
- Out-of-pocket costs
- Provider networks
Aetna members who require assistance in a language other than English should call (888) 982-3862 and ask for an interpreter in their language of choice. Hearing-impaired individuals may receive assistance by calling (800) 628-3323.
If you're considering an Aetna Medicare Advantage plan to get your Medicare Part A and Part B benefits combined into a single plan with extra benefits such as prescription drug coverage, vision, hearing and more, you can compare Aetna plans online to see what's available where you live.