As you near retirement, or assist elderly relatives with health decisions, it’s vital to comprehend whether Medicare covers skin cancer screening and treatment. 

Through Medicare, recipients can access an array of services aimed at early detection and managing skin cancer. This article will serve as a guide to demystify the specifics of what Medicare covers regarding skin cancer, empowering you to make informed choices for yourself or your family members in their pursuit of healthy living.

Does Medicare cover skin cancer screening?

When it comes to skin cancer screenings, Medicare’s coverage can be confusing. Here are three simple points to help you understand when Medicare will, or will not, cover the cost:

• Preventative Screenings: If you want to get checked for skin cancer but don’t have any symptoms, such as changes in moles or new growths, Medicare generally does not cover such visits. 
• Visits for Specific Concerns (Medicare Part B): Now, if you notice something worrisome, like a change in a mole or a new spot on your skin, and you go to the doctor for that reason, Medicare will have your back. In this scenario, Medicare considers such a visit a necessity and will cover it through Medicare Part B, which covers outpatient services including doctor’s visits.
• Incidental Findings During Other Visits (Medicare Part B): Let’s say you went to the doctor for something else entirely – a sprained ankle, for example – and during your visit, the doctor notices a suspicious spot on your skin. If they believe it could be a sign of skin cancer, they can refer you to a dermatologist. In this case, Medicare Part B covers this dermatologist visit.

Additionally, when you first enroll in Medicare Part B, you’re eligible for one full-body exam in the first 12 months of coverage. This is a good opportunity to bring up any skin concerns with your doctor and use it to receive a Medicare-approved dermatology screening. 

If you’re not eligible for a Medicare skin cancer check, there are programs like the American Academy of Dermatology’s Skin Cancer Screening Program and the Skin Cancer Foundation’s Destination Healthy Skin program, which offer free screenings.

Medicare Advantage rules for skin cancer screening

When it comes to Medicare Advantage, it is important to remember that coverage may be different from plan to plan so it is worth checking the details of your specific plan. Some plans cover annual skin checks as parts of their additional benefits, and some don’t. In general, Medicare Advantage coverage of skin screenings is often similar to that of Original Medicare with a couple of differences. First, you might need a referral from your primary care physician to visit a dermatologist. Secondly, you cannot visit just any dermatologist you like – a doctor you choose should be a part of your plan’s network else you’ll end up paying much more out of pocket.

Does Medicare cover skin cancer biopsy?

When a physician believes it is crucial to examine your skin for cancerous cells, Medicare Part B generally covers the expenses for a skin biopsy. In the event that the biopsy reveals the presence of cancer, Medicare extends its coverage to encompass the treatment as well.

However, it’s imperative to remember the fact that individuals are still accountable for meeting deductibles and handling coinsurance costs associated with the procedure and treatment. Thus, patients should be prepared for some out-of-pocket expenses even though Medicare provides substantial support.

Does Medicare cover skin cancer removal?

Medicare does offer coverage for the removal of skin cancer. The exact costs are contingent upon whether the procedure is conducted as an inpatient (under Medicare Part A) or an outpatient (under Medicare Part B).

For inpatient procedures (Medicare Part A)

If the procedure necessitates hospital admission, it will fall under Medicare Part A. Below is a table outlining the costs associated with inpatient care in 2024.

Coverage	Cost
Inpatient hospital deductible	$1,632 (covers first 60 days)
Daily coinsurance (days 61-90)	$408/day
Daily coinsurance (lifetime reserve days post 90 days)	$816/day
Daily coinsurance in skilled nursing facilities (days 21-100)	$204/day

For outpatient procedures (Medicare Part B)

In case skin cancer removal can be done on an outpatient basis, it will be covered under Medicare Part B. The following are the costs for Part B in 2024:

Coverage	Cost
Monthly premium	$174.70 (may be higher depending on your income)
Annual deductible	$240

It’s important for patients to communicate with their healthcare providers to comprehend the nature of the procedure – whether it will be inpatient or outpatient. This information is crucial for patients to prepare financially and to ensure that they make the most of the Medicare coverage available to them.

Does Medicare cover plastic surgery for skin cancer?

Medicare may cover plastic surgery in cases where it is deemed medically necessary following skin cancer removal. When a patient undergoes surgery to remove skin cancer, there can be cases where reconstructive surgery is required to repair damage to the skin and underlying tissues. Medicare generally covers medically necessary procedures, and this can include plastic surgery that is required to repair the affected area after skin cancer removal.

However, it is important to note that Medicare may not cover plastic surgery that is purely for cosmetic reasons. If the surgery is to improve appearance and is not considered medically necessary, it is likely that Medicare will not cover the cost.

Coverage for skin cancer prescription medication

Medicare Part D is responsible for covering prescription medications, and this includes drugs that are prescribed for the treatment of skin cancer. It’s essential for beneficiaries to have a Medicare Part D plan or a Medicare Advantage Plan that includes prescription drug coverage, in order to get help with the costs of skin cancer medications. 

The coverage for skin cancer drugs may vary depending on the specific Part D plan, and it’s wise to review the plan’s formulary, which is the list of covered drugs, to ensure the required medications are included. It’s also important to note that copayments, deductibles, and other out-of-pocket costs may apply for prescription medications under Medicare Part D. Consulting with the plan provider for exact details on medication coverage and costs is recommended.

Does Medicare cover chemotherapy and radiation costs for skin cancer?

Medicare provides coverage for chemotherapy and radiation treatments for skin cancer. If you are admitted to a hospital for these treatments, Medicare Part A covers the inpatient costs. On the other hand, if you receive chemotherapy or radiation treatments in an outpatient hospital setting, a doctor’s office, or a standalone clinic, Medicare Part B covers the costs. It’s crucial for patients to understand which part of Medicare is applicable to ensure a smooth treatment process and be prepared for any associated costs.

Coverage of precancerous skin lesions

Medicare provides coverage for the removal of Actinic Keratoses, precancerous skin lesions caused by sun exposure, through various treatment methods. These include:

• Cryosurgery: Involves the application of liquid nitrogen to eliminate the lesions.
• Topical chemotherapy drugs: Medications are applied directly to the skin to target and treat the lesions.
• Curettage: A procedure that involves scraping away the lesions.
• Photodynamic therapy: A treatment that uses light and a special light-activated substance to destroy precancerous cells.

These covered treatments offer options for patients seeking to address Actinic Keratoses, allowing them to select the approach best aligned with their needs and medical advice.

Summary

In most cases, Medicare doesn’t cover dermatologist checkups. However, if you have any symptoms of skin cancer like moles or new growths, you can visit a doctor that accepts Medicare assignment and Medicare will cover it. 

Rest assured that Medicare covers skin cancer in different aspects, including coverage for certain procedures and medications. However, it’s important to note that there will still be some out-of-pocket expenses, co-payments, and deductibles involved.

Article updated on December 28, 2023.