Medicare covers dermatology, but only for medical reasons — not cosmetic ones

Medicare Part B covers visits to a dermatologist when you have a skin condition that needs medical treatment. This means a dermatologist visit for acne, eczema, psoriasis, skin cancer screening, or a suspicious mole is covered. A visit for Botox, laser hair removal, or wrinkle reduction is not.

You pay 20 percent of the cost after you meet your Part B deductible (which is $240 in 2024, though this amount changes yearly). The dermatologist must be enrolled in Medicare for you to receive this coverage. If you see an out-of-network dermatologist, Medicare will not pay.

The line between medical and cosmetic can blur — for example, removing a mole on your face because it bothers you cosmetically is different from removing one because it shows signs of skin cancer. Your dermatologist and Medicare determine which category applies based on the reason documented in your medical record.

Key Takeaways

  • Medicare Part B covers dermatology visits for medical skin conditions like acne, eczema, psoriasis, and skin cancer screening, but not for cosmetic procedures.
  • You pay 20 percent of the Medicare-approved cost after meeting your $240 annual Part B deductible.
  • The dermatologist must be enrolled in Medicare; if they are not, you will owe the full cost.
  • Medigap or Medicare Advantage plans may cover some or all of your 20 percent coinsurance, depending on your specific plan.

How Medicare decides what counts as medical dermatology

Medicare uses a straightforward rule: the treatment must be medically necessary. That means a doctor documents that you have a skin condition causing symptoms or health risk, and the treatment is standard care for that condition.

Medical dermatology includes removal of precancerous lesions, treatment of infections, management of inflammatory skin diseases, and evaluation of suspicious growths. It also includes some reconstructive work — for example, if you need a skin graft after an injury or surgery, Medicare covers it.

Cosmetic dermatology includes procedures done purely to change appearance: chemical peels for wrinkles, laser resurfacing, Botox, dermal fillers, and hair removal. Even if a dermatologist performs these procedures, Medicare will not pay because the reason is not medical.

The distinction matters because some procedures can be either medical or cosmetic depending on why you are having them done. Removing a mole because it is changing shape or color is medical. Removing the same mole because you do not like how it looks is cosmetic. Your dermatologist documents the medical reason in your chart, and that documentation is what Medicare reviews.

What you pay out of pocket

Your costs depend on whether you have Original Medicare alone or if you also have a Medigap or Medicare Advantage plan.

With Original Medicare only, you pay 20 percent of the Medicare-approved amount for the dermatology visit and any procedures. Before that, you must meet your Part B deductible ($240 in 2024). Once you meet it, you pay 20 percent for the rest of the year. There is no annual out-of-pocket maximum under Original Medicare, so costs can add up if you need ongoing treatment.

If you have a Medigap plan, it typically covers some or all of your 20 percent coinsurance, depending on which Medigap plan you chose. If you have Medicare Advantage, your plan sets its own copay or coinsurance for dermatology visits — this varies widely by plan and by whether the dermatologist is in-network.

The Medicare-approved amount is not the same as what a dermatologist charges. If your dermatologist is enrolled in Medicare, they agree to accept the Medicare-approved amount as payment in full (after you pay your share). If they are not enrolled, you may owe the difference between what they charge and what Medicare would have paid.

Finding a Medicare-enrolled dermatologist

Not every dermatologist takes Medicare. Some practices do not enroll because of paperwork burden or payment rates. Before you schedule, confirm that the dermatologist is enrolled in Medicare.

Use the Medicare Provider Search tool on Medicare.gov. Enter your zip code and search for "dermatology" or "dermatologist." The results show which providers are enrolled in Medicare and whether they are accepting new patients. You can also call your dermatologist's office directly and ask: "Are you enrolled in Medicare?" or "Do you accept Medicare?"

If your dermatologist is not enrolled in Medicare, you have two options. You can pay out of pocket and submit a claim to Medicare yourself (though Medicare will only reimburse you for the Medicare-approved amount, not what the dermatologist charged). Or you can find an enrolled dermatologist in your area.

Skin cancer screening and biopsies

Medicare covers a dermatology visit for skin cancer screening as long as your doctor has documented a medical reason — for example, a family history of melanoma, fair skin with sun damage, or a suspicious lesion you or another doctor noticed.

If the dermatologist performs a biopsy (removing a small sample of skin to test for cancer), Medicare covers that as a procedure. You pay 20 percent of the approved cost. If the biopsy is sent to a lab for analysis, the lab work is also covered under Medicare Part B.

Removal of a skin cancer — whether basal cell, squamous cell, or melanoma — is covered as a medical procedure. This includes the removal itself and any reconstruction needed to close the wound or improve appearance after the cancer is gone. Reconstruction done for medical reasons (to restore function or close a surgical wound) is covered; reconstruction done purely for cosmetic reasons is not.

Treatment of common skin conditions

Medicare covers dermatology visits and treatments for conditions that cause symptoms or health problems. Acne, eczema, psoriasis, rosacea, fungal infections, and warts are all medical conditions. A dermatology visit to diagnose and treat them is covered.

The type of treatment affects your cost. A visit and prescription are covered. Topical medications (creams, ointments) are covered under Part D (prescription drug coverage) if they are on your plan's formulary. Injectable or infused treatments for severe psoriasis or eczema may be covered, but you should check with your plan first because some require prior authorization.

Laser treatment for medical skin conditions — such as laser therapy for severe acne or rosacea — may be covered if your dermatologist documents that it is medically necessary and not cosmetic. However, coverage varies, and your plan may require prior authorization. Always ask your dermatologist to check with Medicare or your plan before the procedure.

Medicare Advantage and dermatology coverage

Medicare Advantage plans must cover everything Original Medicare covers, including dermatology for medical reasons. However, they set their own rules about copays, coinsurance, deductibles, and which dermatologists are in-network.

Some Medicare Advantage plans have a separate dermatology copay (for example, $40 per visit). Others use coinsurance (you pay a percentage). Some plans require a referral from your primary care doctor before you can see a dermatologist. Some limit how many dermatology visits you can have per year.

Before you schedule a dermatology visit, call your Medicare Advantage plan and ask: What is my copay or coinsurance for dermatology? Do I need a referral? Is this dermatologist in-network? Answering these questions first prevents surprise bills.

Frequently Asked Questions

Does Medicare cover mole removal?

Medicare covers mole removal if it is medically necessary — for example, if the mole shows signs of skin cancer, is changing, or is causing symptoms. Removal of a mole purely because you do not like how it looks is cosmetic and not covered. Your dermatologist documents the medical reason, and that determines coverage.

Will Medicare pay for a dermatology visit if I do not have a referral?

Original Medicare does not require a referral to see a dermatologist. You can schedule directly. However, if you have a Medicare Advantage plan, your plan may require a referral from your primary care doctor. Check your plan documents or call your plan to confirm.

What if my dermatologist charges more than Medicare pays?

If your dermatologist is enrolled in Medicare, they must accept the Medicare-approved amount as full payment. You pay only your share (20 percent after the deductible). If your dermatologist is not enrolled in Medicare, you may owe the difference between their charge and the Medicare-approved amount.

Does Medicare cover Botox or other cosmetic procedures?

No. Medicare does not cover any cosmetic procedures, including Botox, fillers, chemical peels, or laser resurfacing done for appearance. If a dermatologist performs these procedures, you pay the full cost out of pocket.

Can I use my Medigap plan to cover dermatology coinsurance?

Most Medigap plans cover some or all of your Part B coinsurance, including dermatology. The amount depends on which Medigap plan you chose. Check your plan documents or call your Medigap insurer to confirm what dermatology costs you will owe.