Does Humana Cover Dermatology?

It’s common for beneficiaries to wonder if dermatology services are covered by insurance companies like Humana and by programs like Medicare.

The short answer is that Humana and other insurance carriers may cover certain dermatology services when they’re medically necessary, while dermatology for purposes that are solely cosmetic may not be covered. 

When Is Dermatology Considered Medically Necessary?

Insurance companies like Humana typically make coverage determinations based on whether a service or item is considered medically necessary or purely cosmetic in nature.

HealthCare.gov defines medically necessary as “Health care services or supplies needed to diagnose or treat an illness, injury, condition, disease or its symptoms and that meet accepted standards of medicine.”

So how does that relate to dermatology? 

If the dermatology being sought is to treat a skin condition, disease, illness or injury or its symptoms, there’s a reasonable chance it will be covered by Humana Medicare plans.

These dermatology services may include treatment for:

• Skin cancer
• Rashes
• Psoriasis 
• Eczema
• Shingles
• Warts
• Keloid scars
• Poison ivy
• Hives and allergies
• Infections

In the case of acne, severe cases are often covered but mild cases may not be covered.

As with anything on the list above, each insurance company may have slightly different coverage guidelines and the only way to know for sure is to contact Humana directly by calling the phone number on your plan ID card or logging into your online MyHumana account to review your plan benefits. 

When Do Humana Medicare Plans Pay for Dermatology?

Medicare may cover dermatology treatment when it’s considered “medically necessary” or “medically appropriate.” If Original Medicare (Part A and Part B) were to cover a medically necessary dermatology treatment, then all Humana Medicare Advantage plans would also cover it.

Medicare Advantage plans like the ones offered by Humana are required to cover everything that Original Medicare covers, and many plans also include extra benefits that Original Medicare doesn’t cover, such as prescription drugs, vision, hearing, wellness program memberships and more.

A Humana Medicare Dermatologist may be necessary in some situations, let’s look at the removal of a benign skin lesion and how it might be covered by Medicare. 

If one or more of the following conditions are present and documented in the beneficiary’s medical record, the removal of a benign lesion will be covered:

• Lesion has become symptomatic or undergone a change in appearance or displays evidence of inflammation or infection
  
  
• The lesion obstructs an orifice or restricts eye function
  
  
• There is clinical uncertainty as to the likely diagnosis
  
  
• An exam or biopsy indicates atypia or malignancy
  
  
• The lesion is in an anatomical region subject to recurrent physical trauma and documented trauma has occurred
  
  
• The procedure involves the removal of molluscum contagiosum
  
  
• There’s a benign epidermal or pilar cyst with a history of infection, drainage or rupture
  
  

Medicare will not cover the removal of a benign lesion if any of the following are true:

• The lesion does not pose a threat to health or function and is considered cosmetic.
  
  
• The lesion is located in a sensitive anatomical location and is not creating problems.

As you can see from the above example, there are several terms and conditions that must be met for the removal of a benign lesion to be covered, and most dermatology services will include their own terms and conditions.

Insurance companies like Humana will typically use similar requirements in determining coverage of dermatology care. 

If your dermatology treatment involves medications, those prescription drugs may be covered by your Humana Medicare Advantage plan.

Humana Medicare Advantage plans can also cover over-the-counter health products that may include dermatology creams and other products and may also cover additional dermatology services or products not covered by Original Medicare.  

Humana is among the leading providers of Medicare Advantage plans. If you are enrolled in a Humana Medicare Advantage plan, contact your plan directly to learn more about your dermatology benefits.

If you are not yet enrolled, contact a licensed insurance agent who can help you review the plans available in your area from Humana and other insurance carriers.