Have you been diagnosed with skin cancer? Or, do you know someone who has been?
The good news is that it is typically not as dangerous as other well-known cancers such as breast cancer. However, skin cancer is still cancer and can still be dangerous.
Like many types of cancer, it is best treated in its early stages. One of the ways you can treat skin cancer is through Mohs surgery.
If this course of treatment has been recommended to you or a loved one, you may be wondering, “Does Medicare cover Mohs Surgery?”
In this article, we answer the question in clear, plain English. You will also find the average costs of going through Mohs surgery for those who have to pay out of pocket.
Does Medicare Cover Mohs Surgery?
The short answer is yes; Medicare will cover the cost of Mohs surgery. But this is not the case 100% of the time. As is often the case with Medicare, certain conditions have to be met for Medicare to pay for your Mohs surgery. Below we look at what these are so you know what to expect.
Original Medicare Coverage of Mohs Surgery
Original Medicare (Medicare Part A and Part B) provides coverage for Mohs surgery. This plan provides coverage for Mohs surgery if it is considered medically necessary. Therefore, your healthcare provider must first order the operation for Original Medicare to provide coverage.
When is Mohs Surgery Covered by Part A?
Coverage for Mohs surgery is provided by Medicare Part A if your surgery takes place in an inpatient setting. Medicare Part A will cover 100 percent of the costs of hospital stays for up to 60 days.
Starting from the 61st day up to 90 days, Medicare Part A will still provide coverage. However, you will pay a copayment each day. After 90 days, Medicare Part A will no longer provide coverage.
It is important to know that Medicare Part A provides 60 lifetime reserve days. If you have them, they will still provide coverage for your hospital stay after 90 days, but, again, there is a daily copayment you are responsible for.
When is Mohs Surgery Covered by Part B?
On the other hand, coverage for Mohs surgery is provided by Medicare Part B if it takes place in an outpatient setting. Once approved, Medicare Part B covers 80 percent of the costs of Mohs surgery. You will pay for the remaining 20 percent.
Medicare Advantage Coverage of Mohs Surgery
Medicare Advantage plans (Medicare Part C) also provide coverage for Mohs surgery. They must cover the same treatments, services, etc., that Original Medicare covers.
These plans offer additional benefits as well that Original Medicare does not cover. Precisely what a Part C plan covers and how much the out-of-pocket costs vary depending on your plan.
Additionally, there is Medicare Part D. This is a prescription drug plan, and just like Medicare Part C, these plans are provided by private insurance companies. Medicare Part D plans provide coverage for medications you need after Mohs surgery.
Now, what about reconstructive surgery after Mohs surgery? Does Original Medicare cover it?
Medicare Coverage of Reconstructive Surgery
The short answer is no; in most cases, Medicare will not cover the cost of reconstruction after Mohs surgery.
That being said, there may be some situations where you can get these costs covered. Below we’ll take a closer look at this to see when you might be able to get Medicare to pay for your reconstruction after Mohs surgery.
Original Medicare Coverage of Reconstructive Surgery
Original Medicare (Medicare Part A and Part B) does not provide coverage for reconstruction after Mohs surgery.
Reconstructive surgery after Mohs surgery is considered cosmetic surgery. Most of the time, Original Medicare does not provide coverage for cosmetic surgeries.
That is because cosmetic surgeries are not considered medically necessary. And reconstructive surgery after Mohs surgery is not considered medically necessary.
What is the Cost of Mohs Surgery?
Mohs surgery costs a little over $1,200 on average, but this may differ depending on factors such as the location of the cancerous mole on your body and what part of the country you live in.
Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage. 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.
Additional Info on Medicare Coverage
This article is part of our series on “What does Medicare cover?”
Also, you can check out other articles in this series, including: Does Medicare Cover The Medtronic 670g?