Does Medicare Cover Acne Treatment?

Acne is an issue that most commonly affects teenagers and young adults. Some common causes are hormones, stress, and sometimes even hygiene. However, acne is not a skin condition limited to teens.

There are people in their senior years who do experience acne breakouts. It can be quite a hassle to treat effectively. Though there are a number of ways to treat acne available.

If you are a senior and are looking for ways to treat your acne, you may be wondering “Does Medicare cover Acne Treatment?”

In this article, we answer the question in clear, plain English. This way you’ll know what to expect when it comes to coverage.

Does Medicare Cover Acne Treatment?

The short answer is no. In most cases, Medicare will not cover the cost of acne treatment.

Though there may be some situations where you can get these costs covered by Medicare. Below we’ll take a closer look at this to see when you might be able to get Medicare to pay for your acne treatment.

Original Medicare Overall Coverage of Acne Treatment

Original Medicare (Medicare Part A and Part B) does not provide coverage for acne treatment. So that means you will have to pay 100 percent for your acne treatment.

Original Medicare will only provide coverage for acne treatment if medically necessary. Usually that means it is a symptom of a more severe medical condition.

Medicare Part B Coverage of Medically Necessary Skin Treatments

Medicare Part B provides coverage for dermatology services such as screenings and diagnostic services for hair, nails, and skin conditions.

Part B provides coverage for skin cancer services such as screenings like biopsies and treatment as long as they are medically necessary.

However, Medicare Part B does not provide coverage for dermatology services that are not considered medically necessary. For example, for cosmetic dermatology services such as acne treatment, you will not be able to attain coverage.

Medicare Part C Coverage of Acne Treatment

If you have a Medicare Advantage plan (Medicare Part C), your plan may provide at least some coverage for acne treatments. Medicare Advantage plans have to cover everything Original Medicare covers. But these plans offer additional coverage for treatments and services that Original Medicare does not cover. Exactly what a plan covers and how much the out-of-pocket costs will be vary from plan to plan.

There are some Medicare Advantage plans (Medicare Part C) that provide coverage for acne treatment.

Part C plans that include prescription drug plans may provide coverage for medications that your healthcare provider may prescribe to help treat acne.

Medicare Part D Coverage of Acne Treatment

Medicare Part D plans may also provide coverage for acne prescription drugs. Part D is a prescription drug plan available to those with Medicare. Like Medicare Part C, Medicare Part D plans are provided by private insurance companies.

To give you an idea of coverage, 86 percent of both Medicare Part C and Part D plans provide coverage for the medication Accutane.

Accutane is listed as a tier 4 drug in the Medicare drug formulary and was recently approved by the FDA to treat acne.

Most of the time, the Medicare drug formulary only has five tiers. Tier 4 medications are more expensive than Tier 1, 2, and 3 medications.

Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage and Medigap plans. Always be sure to double check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.