Does Medicare cover a full-body skin exam?

Full-body skin exams are a preventative health service where a dermatologist checks the skin, hair, and nails for melanoma or other types of cancer. But does Medicare cover a full-body skin exam?

This will vary depending on the Medicare plan type. Below, we’ll look at the details for each plan type to give you an idea of whether you might be covered or not.

Learn more about Medicare Medigap plans in our guide, What are Medicare Supplement Insurance Plans (Medigap)?

If you need help finding health insurance, use our free tool above by entering your ZIP code to compare health insurance quotes in your area.

Does Medicare cover a full-body skin exam?

Because full-body skin exams are preventative, original Medicare (Medicare Part A and Part B) will usually not cover them, unless they are being done by a dermatologist due to concern over a new skin growth, varied pigmentation, or some other potential sign of a skin disorder.

Medicare Advantage (Medicare Part C) may cover full-body skin exams as a preventative measure and/or due to concerns. This will depend on your individual policy, so it is best to check with your policyholder regarding this question.

There are also some programs that offer free skin cancer screenings, such as the SPOT me Skin Cancer Screening Program.

What dermatology services does Medicare cover?

Medicare will usually cover dermatology services that are medically necessary, meaning that they are being used as a treatment for a specific reason.

Medicare Part B and Medicare Advantage will usually cover a skin biopsy if there is the presence of any suspicious signs or symptoms of skin-related disorders.

Medicare will also usually cover treatments for disorders, such as rosacea, psoriasis, or eczema. If you are prescribed medication for these disorders, Medicare Part D should cover them as long as they are on the approved drug list.

Regardless of what Medicare will cover, you will most likely have some out-of-pocket expenses, including your premium, deductible, and coinsurance or copayment.

You can get a better understanding of what your costs may be by reading our guide, What is the maximum out-of-pocket expense with Medicare?

Exploring Medicare Advantage Coverage: Case Studies on Cataract Surgery

Case Study 1: John’s Experience With Medicare Advantage and Cataract Surgery

John is a 68-year-old retiree who has been enrolled in a Medicare Advantage plan for the past two years. He recently started experiencing vision problems and was diagnosed with cataracts. Concerned about the cost of cataract surgery, John contacted his Medicare Advantage plan to inquire about coverage.

After reviewing his plan’s benefits, John discovered that his Medicare Advantage plan does cover cataract surgery. However, he learned that he would need to follow certain guidelines to ensure coverage. His plan required him to obtain a referral from his primary care physician and see an ophthalmologist who participates in his plan’s network.

John was relieved to find out that he could proceed with the surgery without incurring substantial out-of-pocket expenses.

Case Study 2: Sarah’s Frustration With Medicare Advantage and Cataract Surgery

Sarah, a 72-year-old Medicare Advantage plan member, was recently diagnosed with cataracts. She scheduled an appointment with an ophthalmologist, assuming her Medicare Advantage plan would cover the necessary surgery. However, to her disappointment, Sarah found out that her plan did not cover cataract surgery.

Sarah had chosen her Medicare Advantage plan primarily for its comprehensive coverage, but she had overlooked the specific details regarding ophthalmological procedures. Now facing the prospect of paying for the surgery out of pocket, Sarah felt frustrated and burdened by unexpected expenses.

She realized the importance of thoroughly researching and understanding the coverage details of her health plan in the future.

Case Study 3: Mark’s Medicare Advantage Plan and Cataract Surgery

Mark, a 74-year-old Medicare Advantage plan member, was diagnosed with cataracts during a routine eye examination. He reviewed his plan’s coverage and was relieved to find out that cataract surgery was included. However, his plan required him to meet certain criteria to be eligible for coverage.

Mark’s Medicare Advantage plan mandated that he exhaust all non-surgical treatment options for cataracts before being considered for surgery. This included trying corrective lenses and undergoing regular vision check-ups. Additionally, Mark’s plan required him to obtain prior authorization from the plan administrator to proceed with the surgery.

While initially frustrated by the additional steps and potential delays, Mark understood that these measures were in place to ensure the appropriate utilization of healthcare resources. He followed the plan’s guidelines and ultimately received the cataract surgery with full coverage from his Medicare Advantage plan.

Mark appreciated the emphasis on conservative treatment and the plan’s commitment to managing healthcare costs effectively.

Conclusion

As a preventative measure, original Medicare will usually not cover a full-body skin exam. However, it may cover them if they are being done as a screening for skin cancer or a potential sign of a skin disorder.

Medicare Advantage may cover full-body skin exams, both as a preventative measure and/or due to concerns, but you should check with your policyholder to make sure.

If you need help finding a dermatologist, check out our guide, Best Dermatologists That Will Accept Medicare.

If you need help finding an affordable healthcare plan in your area, use our free comparison tool below by entering your ZIP code.