What Medicare Covers for Skin Checkups

Medicare Part B covers a skin cancer screening once every 12 months if your doctor refers you for one. The screening must be performed by a dermatologist or your primary care doctor and documented as a preventive visit. Medicare pays 100% of the cost after you have met your Part B deductible — you pay nothing for the visit itself if your doctor accepts Medicare assignment.

The screening covers a visual examination of your entire skin surface to look for signs of skin cancer, including melanoma and non-melanoma types. If your doctor finds a spot that needs closer inspection or removal, that becomes a separate procedure with its own cost rules. A screening is not the same as a biopsy or removal, and Medicare treats them differently.

You do not need symptoms or a previous skin cancer diagnosis to get a screening. Your doctor can order one as a preventive measure, and Medicare will cover it. However, the screening must be ordered by a physician — you cannot straightforward schedule one on your own and expect Medicare to pay.

Key Takeaways

  • Medicare Part B covers one skin cancer screening per year at no cost to you after your deductible is met, as long as your doctor orders it.
  • The screening must be performed by a dermatologist or primary care doctor and documented as a preventive service to may have access to for coverage.
  • If your doctor finds a suspicious spot and removes it or takes a biopsy, that procedure is billed separately and may have a copay or coinsurance.
  • You do not need to have had skin cancer before or have symptoms to get a screening — your doctor can order one for prevention.
  • If your doctor does not accept Medicare assignment, you may owe more out of pocket, so confirm this before your visit.

When a Screening Becomes a Procedure with Additional Costs

A preventive skin cancer screening is covered at no cost. But if your doctor finds something suspicious during that screening and decides to remove it, biopsy it, or treat it, that work is no longer a screening — it becomes a treatment procedure. Medicare will cover the procedure, but you may owe a copay or coinsurance depending on your plan.

For example, if your dermatologist removes a mole or lesion during the same visit, Medicare typically covers 80% of the removal cost after your deductible, and you pay 20%. If a biopsy is taken, the same rule applies. The key is that the removal or biopsy must be medically necessary — not cosmetic — for Medicare to cover it.

Ask your doctor before the visit whether they expect to remove or biopsy anything. If they do, ask what your out-of-pocket cost will be. Some dermatologists can give you an estimate based on the size and location of the spot.

How to Make Sure Medicare Pays

First, ask your primary care doctor or dermatologist to order the screening as a preventive service. The order matters because it tells Medicare this is a screening, not a diagnostic visit for a known problem. Your doctor's office should code it correctly when they submit the claim.

Second, confirm that your doctor accepts Medicare assignment. If they do, Medicare pays them directly and you owe nothing (after your deductible). If they do not accept assignment, they can charge you up to 15% more than Medicare's approved amount, and you will owe the difference.

Third, bring your Medicare card to the appointment. Your doctor's office will need to verify your coverage. If you have a Medigap or Medicare Advantage plan, bring that card too — some plans cover the deductible or coinsurance differently.

What Happens If You Have a Medicare Advantage Plan

Medicare Advantage plans (Part C) must cover the same preventive skin cancer screening at no cost, just like Original Medicare. However, you must use a dermatologist or doctor in your plan's network, or you may owe more. Check your plan's provider directory before scheduling.

Some Medicare Advantage plans cover additional skin services — such as more frequent screenings or cosmetic removal — but this varies by plan. Call your plan's customer service number (on the back of your card) and ask what skin services are covered and whether you need a referral.

Skin Checks That Medicare Does Not Cover

Medicare does not cover cosmetic skin procedures, even if a dermatologist performs them. If you want a mole or spot removed purely for appearance and your doctor agrees it is not medically necessary, you pay the full cost out of pocket.

Medicare also does not cover routine skin care visits that are not related to cancer screening or treatment — for example, a visit for acne treatment or general dermatology information. If your doctor documents the visit as preventive skin cancer screening, it is covered. If they document it as a general skin condition visit, it may not be.

Some dermatologists offer full-body photography or digital mapping to track changes in moles over time. These tools are not separately covered by Medicare, though your doctor may include them as part of a covered screening visit at no extra charge to you.

How Often Medicare Covers Screenings

Medicare covers one skin cancer screening per 12-month period. This means you can have one screening per calendar year. If you have had a screening and want another one within the same 12 months, Medicare will not cover the second one unless your doctor documents a medical reason — such as a family history of melanoma or a previous skin cancer diagnosis.

If you have a history of skin cancer, your doctor may recommend more frequent screenings. In that case, ask your doctor to document the medical reason in your chart. Medicare may cover additional screenings if they are medically necessary, not just preventive.

What to Bring and Expect at Your Appointment

Bring your Medicare card, any secondary insurance card (Medigap or Medicare Advantage), and a photo ID. Wear clothes that allow your doctor to see your entire skin — shorts and a sleeveless top are typical. The screening usually takes 10 to 20 minutes.

Your doctor will examine your skin from head to toe, looking for any spots that show signs of skin cancer. They may use a dermatoscope (a magnifying tool) to get a closer look. If they find anything suspicious, they will discuss options with you — observation, biopsy, or removal — and explain the costs.

After the visit, your doctor's office will submit the claim to Medicare. You should receive an Explanation of Benefits (EOB) in the mail within a few weeks. Review it to make sure the screening was coded as preventive and that you were not charged a copay.

Frequently Asked Questions

Do I need a referral from my primary care doctor to see a dermatologist for a skin cancer screening?

Original Medicare does not require a referral. You can see any dermatologist who accepts Medicare. However, if you have a Medicare Advantage plan, you may need a referral to stay in network and avoid higher costs. Check your plan's rules before scheduling.

What if my dermatologist finds a spot and wants to remove it at a later appointment?

That is fine. The screening visit is covered at no cost. When you return for the removal, that visit is a separate procedure and may have a copay or coinsurance. Ask your doctor's office for an estimate before the removal appointment.

Will Medicare cover a skin check if I go to an urgent care or walk-in clinic instead of a dermatologist?

Yes, if a doctor at the urgent care orders it as a preventive skin cancer screening and documents it that way. However, urgent care clinics may not have dermatologists on staff, so the quality of the screening may vary. A dermatologist is trained specifically in skin cancer detection.

Can I get a skin cancer screening more than once a year if I have a family history of melanoma?

Medicare's standard coverage is one screening per 12 months. If your doctor believes more frequent screenings are medically necessary due to your personal or family history, they can document that reason and request coverage for additional screenings. Medicare may approve them, but it is not automatic.

What if my dermatologist does not accept Medicare assignment?

You can still see them, but you may owe more. Non-participating doctors can charge up to 15% above Medicare's approved amount. Ask the office about their fees before your appointment, and confirm whether they will bill Medicare directly or if you will need to pay upfront and seek reimbursement.