Know your Coverage: Dermatology and Health Insurance

Understanding dermatology and health insurance may seem complicated. Yet, your skin journeys with you throughout life and many people avoid or overlook going to the dermatologist because they don’t know if their health insurance will cover it.

Sure, a yearly skin cancer screening is recommended, and it would be nice to get your teenager’s acne or your own eczema under control. But many people worry about high deductibles and copays and delay scheduling an appointment with a dermatologist.

Dermatology and health insurance

It’s hard to know what’s the best health insurance for dermatology. If an employer covers you, you may have limited options for health care plans. If you’re self-employed, you may have to go with a high-deductible plan to afford the premiums.

Are you confused about health insurance for dermatology? Does your health insurance for dermatology cover telehealth? Do you need a referral? Which skin conditions are best treated by a dermatologist rather than a regular doctor? It can be tough figuring out the best health insurance for dermatology care.

It’s worth doing your research and calling your insurance provider to find out exactly what is covered for dermatological services. Your benefits may have changed in 2021, and COVID-19 has given providers more flexibility to do telehealth.

What health insurance typically covers

If you’ve been diagnosed with a chronic skin condition or something as serious as skin cancer, you should prioritize health insurance for dermatology. Those office visits can quickly add up, along with in-office treatments and prescription medicine.

When selecting a plan, make sure it will meet all of your health needs – including your skin. Insurance providers offer varying levels of coverage for dermatological services. Most private insurance plans cover visits when deemed medically necessary, but they don’t cover cosmetic procedures.

A dermatologist specializes in diagnosing and treating disorders that affect your skin, hair, and nails. You may or may not need a referral from your primary care physician, so it’s best to call and discuss your benefits in advance.

A qualifying condition that’s medically necessary due to a health-related issue should be covered. These may include chronic skin conditions, autoimmune disorders, cancers, and related chronic illnesses that are progressive or comorbidities.

The best health insurance for dermatology typically covers a variety of medical conditions:

• Allergies
• Dermatitis
• Eczema
• Hemangiomas
• Hives
• Infections and rashes
• Keloid scars
• Unusual moles
• Melanoma
• Molluscum Contagiosum
• Poison Ivy
• Psoriasis and psoriatic arthritis
• Rashes
• Rosacea
• Severe Acne
• Shingles
• Skin cancer
• Vitiligo
• Warts
• Other health-related skin issues

It’s best not to guess on which skin conditions are deemed medically necessary. Review your health insurance plan or contact your company’s benefits specialist or the insurer directly – and take notes on what they say. If it’s too late to change your plan for 2021, make sure to do your homework and find a plan that includes dermatology treatments.

Ask about coverage for teledermatology

In the wake of COVID-19, many insurance providers have started covering telehealth visits or teledermatology. It’s also been growing in popularity for simple convenience. You should contact your insurance provider to see if telemedicine is included under your plan, either temporarily during COVID-19 or as an ongoing benefit. Also, ask what is covered or if there is a cap on televisits.

APDerm now offers teledermatology and accepts most insurance carriers in Massachusetts, New Hampshire, and Rhode Island. You also can call to verify if we accept your insurance or if you need a referral before scheduling an appointment.

The Telederm program offers private dermatological appointments via phone or video from the comforts of your home. Like an in-office visit, your dermatologist can diagnose and treat many skin, hair, and nail conditions through telehealth consultations.

Some benefits of Telederm include:

• Safe, secure, and convenient
• Fast, flexible appointments
• Hassle-free – don’t worry about getting dressed, driving, or running late
• Email or upload photos of affected areas
• Continue with your treatment plan
• Easy online prescriptions and refills sent to a pharmacy
• Covered by Medicare and most insurances during COVID-19
• Complete paperwork electronically

If you need a referral, you should contact your primary care doctor and ask them for a referral. It also may be worth calling your insurance company and speaking with a benefits specialist. They are the best expert on your coverage and can explain what you need to do so your care is covered.

Also, be sure to ask about copays and other benefit changes due to the pandemic. Major insurance companies such as Blue Cross Blue Shield, United Health Care, Aetna, Cigna, Fallon, and others waive copays and deductibles. You’ll want to verify for how long and for what type of services specific to your plan.

If you have a self-funded or high deductible plan, you’ll likely still have to pay copays and deductibles. And in a constantly changing insurance market, it’s hard to say whether telehealth is here to stay.

Low-cost care if you don’t have health insurance

Public health programs and coverage for low-income and the uninsured have expanded in recent years. Search Benefits.gov or contact your state’s Department of Health and Human Services. You may qualify for Medicaid or a subsidized health plan that includes health insurance for dermatology.

Some health clinics offer free skin cancer screenings. If you’re worried about an unusual spot or do get the dreaded C word diagnosis, seek a qualifying health clinic for follow-up care. Some clinics will treat you even if you don’t have health insurance.

If it’s a serious or persistent skin condition, don’t ignore it. Call a dermatologist’s office and ask if it accepts patients without insurance. Inquire about a discount if you pay cash or a sliding-fee scale based on your income. If they decline to see you, ask for a recommendation or a referral for a clinic that can help you.

Prescription costs also deter many from seeking treatment. The good news is there are several resources for reduced copays or low-cost prescription drug programs for people with and without insurance. The Partnership for Prescription Assistance, RxAssist, RxHope, Blink Health, and Good Rx are a few to check out.

Even an Assistance Fund helps patients who have melanoma to pay for medicine, health insurance, and the costs not covered by health insurance.

Medicare coverage for dermatology services

Your risk of developing skin cancer increases with age. It’s also a serious health issue. Most skin cancer cases – and 50 percent that lead to death – occur in people 65 years and older. And less than half of older adults protect their skin from the sun.

Years of sun damage can lead to sun spots or precancerous lesions. As you age, other skin problems include rough or dry skin, benign growths, thinning skin, or bruising easily.

If you’re a senior, it’s important to establish a relationship with a dermatologist and visit them at least once a year. You’ll also want to investigate health insurance for dermatology and coverage options if you need recurring treatment.

Original Medicare, which includes Part A and B, provides healthcare for Americans age 65 and older. Routine and cosmetic dermatology services, including a routine full-body skin exam, typically are not covered by original Medicare.

However, Medicare Part B usually covers office visits to diagnose or treat a medical condition. That includes dermatology care if it’s shown to be a medical necessity, such as a skin exam or biopsy to detect skin cancer or treat a chronic skin condition.

You’ll want to make sure your dermatologist accepts Medicare, and you’ll likely have to pay 20% of the Medicare-approved amount for the office visit. You can search for a dermatologist via Medicare.gov’s physician compare tool or research covered services via the coverage page.

Some Medicare Advantage Plans, known as Part C, do include dermatology services but may have monthly premiums, deductibles, and copays. It may be worth investing in Part C or a private supplemental policy, depending on your health situation.

If you’re nearing age 65, or want peace of mind, give your Medicare Advantage provider a call to discuss your coverage and whether you need a doctor’s referral to see a dermatologist.

Bottom line: Don’t let fear and frustration over health insurance for dermatology care – or COVID-19 – keep you from getting treatment. Contact APDerm today if you want to learn more about teledermatology or have questions about what your insurance covers.