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Are dermatologists covered by health insurance?

The lowdown...
  • Many health insurance plans do cover dermatology visits
  • However, it can vary depending on your insurance company and the type of plan that you have
  • Dermatology visits are not considered one of the ten essential health benefits under the Affordable Care Act so insurance companies are not required to cover it
  • Medicare usually covers dermatology visits if they are deemed medically necessary
  • If you have an HMO health insurance plan, you may have to get a referral from your primary care provider before you can see a dermatologist

How do I know if my health insurance plan covers dermatologist visits?

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The best way to find out exactly what your health insurance plan covers is to speak to a representative at your insurance company or look through your benefits summary. Each insurance plan is different and coverage can vary for each plan.

Many of the services that dermatologists provide can be considered elective cosmetic procedures and are therefore not considered medically necessary. Most insurance plans do not cover services that are not medically necessary. Some of the most common medical conditions that are covered by health insurance include skin cancer, infections, psoriasis, shingles, and eczema. Many health insurance plans now cover acne, as well.

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The removal of port wine stains is another procedure that is now commonly being covered by insurance companies. In the past, this may have been seen as an elective procedure. However, Minnesota recently passed a law requiring health insurance companies to cover port wine stain removals so more policymakers, states, and insurance companies are seeing this procedure as medically necessary.

Some dermatology services that are not considered medically necessary and most likely won’t be covered by your health insurance include botox, chemical peels, and tattoo removal.

Is dermatology coverage required under the Affordable Care Act?

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Dermatology coverage is not required under the Affordable Care Act because it is not considered one of the 10 essential health benefits. These essential benefits include emergency services, hospitalization, prescription drugs, lab services, and preventative services. In some cases, dermatology visits may count as preventative services. It is important to compare plans and their benefits summary before choosing a plan, so you can get one with dermatology coverage if that is necessary for you.

One important change that did occur under the Affordable Care Act is that companies are no longer able to deny you coverage because of a pre-existing condition. If you have any kind of dermatology condition or skin cancer that may have previously made it difficult for you to get insurance coverage, you no longer have to worry. Your insurance company also cannot drop you if you get sick and you have the right to appeal decisions or denials made by your insurance company.

Does my Medicare insurance cover dermatologists?

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Medicare Part B covers most dermatology services if they are considered medically necessary. Medicare Part A, which is free for those who are eligible, does not cover visits to the dermatologist’s office because it only offers hospital coverage. You will have to purchase Medicare Part B or a Medicare advantage plan if you want dermatology coverage through Medicare.

These plans will typically cover 80 percent of your dermatology procedure if it is considered medically necessary and you will be responsible for paying the other 20 percent. When looking for a Medicare advantage coverage, compare plans that have dermatology services listed in their benefits summary.

Does my HMO insurance plan cover dermatology visits?

Dermatology coverage will vary with each individual health insurance plan. If you have an HMO plan, you will most likely only be able to see a dermatologist with a referral from your primary care provider. You will also only be able to see physicians within your plan’s network.

If you see a provider outside of your network or attempt to see a specialist without a referral, it is unlikely that your insurance company will cover the cost.

Premium costs for HMOs are generally less expensive due to this in-network structure.

Does my PPO insurance plan cover dermatology visits?

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PPO plans give you more flexibility in your choice of providers. However, dermatology coverage will still vary on a plan to plan basis. With PPO coverage, you do not need a referral from your primary care provider to see a dermatologist or any other type of specialist. With these plans, monthly premiums are generally higher and you may have to pay a deductible amount before your insurance coverage kicks in.

Are dermatologists covered by health insurance?

Dermatology coverage will vary depending on your insurance company. Most health insurance plans, including some Medicare plans, will cover your dermatology visits if it is medically necessary. You will most likely have to pay some out of pocket costs such as a copayment, coinsurance, or a deductible.

If you have an HMO plan, you will need a referral from your primary care provider before seeing any specialist including a dermatologist.

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