Unfortunately, it’s not as simple as a yes or no answer. In many instances, it depends on the individual’s health insurance plan and what treatments they’re receiving. 

In this article, we’ll be discussing what dermatology is, what dermatology services are and are not covered by insurance, how to find a dermatologist, and more.

What is dermatology?

Dermatology is a branch of medicine that focuses on skin disorders. Dermatology is all about diagnosing, treating, and preventing various skin issues. For the most part, dermatology is broken up into two categories: cosmetic dermatology and medical dermatology. 

Medical dermatology

Medical dermatology refers to skin conditions of a medical nature. Examples of this include eczema, psoriasis, and skin cancer. Your skin doctor can tell you if your condition is of a mandatory medical nature or if it is an elective procedure of a cosmetic nature. If you’re dealing with a medical dermatology issue, it’s imperative to take care of it as soon as possible.

Is medical dermatology covered by insurance?

Yes, medical dermatology is typically covered by insurance because it involves the diagnosis and treatment of skin conditions, which are considered medically necessary services.

Cosmetic dermatology

Cosmetic dermatology refers to procedures for the skin that are designed to improve its appearance and health. The problem can be due to aging, sun damage, or skin scarring. Essentially, with cosmetic dermatology, the patient wants to enhance his or her skin but not due to a medical need. If your desired skin procedure is a cosmetic one, it is your choice whether to go through with it. Examples of such practices include dermal fillers, DOT therapy, and hair removal.

Is cosmetic dermatology covered by insurance?

No, cosmetic dermatology is generally not covered by insurance because it is considered elective and primarily for aesthetic enhancement rather than medical necessity.

Understanding What is Covered By Insurance

What types of dermatologist procedures are covered by most insurance plans?

These treatments often encompass not only the diagnosis but also the management and therapy for various skin conditions. Your coverage is likely to extend to things like:

• Acne Treatments: This can include topical treatments, oral medications, and in some cases, procedures like chemical peels or laser therapy when deemed necessary.
• Skin Cancer Treatment and Removal:
  • Surgical procedures for removing skin cancer, such as Mohs surgery, excision, or cryotherapy.
  • Follow-up care and any necessary reconstructive surgery after skin cancer removal.
  • Radiation therapy or chemotherapy if required for skin cancer treatment.
• Psoriasis Management: Treatments including topical treatments, phototherapy, and systemic medications.
• Eczema (Atopic Dermatitis) Treatments: Including prescription creams, phototherapy, and systemic treatments when over-the-counter options are insufficient.
• Infections and Rashes: Treatments for skin infections, fungal infections, and persistent rashes, which may involve both topical and oral medications.
• Wound Care for Chronic or Non-Healing Wounds: Specialized dressings, medications, and potentially advanced therapies for wounds that are slow to heal, often related to underlying conditions like diabetes.
• Diagnosis and Treatment of Other Skin Disorders: This includes a wide range of conditions like rosacea, vitiligo, shingles, and others, where treatment is necessary to manage symptoms or prevent complications.

It’s important to remember that the extent of coverage for these treatments can vary based on your specific insurance plan, and some treatments may require prior authorization or referral from a primary care physician. Additionally, while the treatment itself may be covered, there might still be copays, coinsurance, or deductibles that apply.

What types of dermatologist procedures are not covered?

You can expect that anything that is not medically necessary to not be covered by your health insurance plan. This typically includes cosmetic treatments like:

• Facials
• Botox
• Fillers

How do I know if my insurance covers my dermatology treatment?

Whether your insurance covers your dermatology treatment ultimately depends on the type of plan you have and what that plan covers. The best way to determine this is to read through your literature for your insurance plan.  If you still have questions, you can also connect with their customer service department and ask.

Insurance Plans and Dermatology

What type of health insurance is best for covering dermatology?

There is no objective “best” type of health insurance for dermatology coverage. Understanding your individual policy is key to maximizing your available benefits. If access to dermatological care is a priority for you, it may be a good idea to double check your plan details before enrolling to make sure you have access to and coverage for the care you need.

Do I need a referral to see a dermatologist?

This depends on your health insurance plan:

• HMOs, or Health Maintenance Organization plans, require you to name a primary care doctor who coordinates your care. With this type of plan, you will have to receive a referral from your primary care physician in order to see a dermatologist.
• PPOs, or Preferred Provider Organization plans, will typically allow you to have access to a wider range of treatment providers and covered care than what is available with HMO coverage. You may not have to receive a referral.

Is dermatology covered by Medicaid?

Yes, dermatology services are generally covered by Medicaid, but the extent of coverage can vary by state. Medicaid typically covers medically necessary dermatological treatments, such as for skin diseases, infections, or injuries. However, coverage for specific procedures and the need for prior authorization might differ between states. Cosmetic dermatology procedures, not deemed medically necessary, are usually not covered. It’s advisable to check with your state’s Medicaid program for specific coverage details.

How much do dermatology treatments cost?

Dermatology treatments can vary is cost, typically ranging from $30 to $250, depending on the type of treatment, location, dermatology office and insurance type. This fluctuation is influenced by factors such as your insurance coverage, the format of the visit (virtual or in-person), the healthcare facility, and the specific type of skin treatment you’re undergoing.

Some conditions that dermatologists typically treat are:

• Acne
• Melanoma (skin cancer)
• Psoriasis
• Eczema
• Dermatitis
• Keratosis
• Hair disease/ hair loss
• Rosacea
• Moles/ Warts/ Growths
• Skin Lesions
• Canker sores
• Vitiligo

If you possess a high-deductible health plan or lack insurance coverage, the expenses for dermatology appointments could be higher for you. Moreover, elective procedures typically incur greater costs compared to treatments for medically necessary conditions. For example, while your insurance might cover psoriasis treatment, it may not extend to hair loss treatment. It’s advisable to consult both your healthcare provider and insurance company to ascertain the coverage of your plan before proceeding with any procedure.

How can I make my dermatology treatments more affordable?

In the event you do not have insurance coverage, one way you can make dermatology treatments more affordable is to ask your specialist if they have a payment arrangement you can make. Another way is to inquire if they have offered any kind of discount. However, the best way to make your dermatology treatments more affordable is to have a health insurance plan. Fortunately, you can find a variety of health insurance plans on eHealth and choose a plan that covers the dermatology treatments you’re looking to receive.

How do I find health insurance that covers dermatology?

As the first and largest online health insurance brokerage, eHealth can help you easily compare all available individual and family health insurance plans to find one that fits your budget and coverage needs. If you want to make sure your dermatology needs are covered by a health insurance plan, eHealth’s team of licensed agents can be reached over the phone or via chat to assist you as well. Get started today with eHealth.