Phototherapy, also known as light therapy, is a treatment for various medical conditions. Depending on the type of light therapy, it uses artificial or natural light to improve your health.
It is also a “last resort” treatment for psoriasis. This skin condition can be managed by over-the-counter or prescription creams and medications.
So, a common question many people have is, “Does Medicare cover phototherapy for psoriasis?” In this article, we answer that question in clear, plain English. You will also find the average costs of light therapy for psoriasis if you have to pay for it yourself.
Does Medicare Cover Phototherapy For Psoriasis?
The short answer is yes; Medicare will cover the cost of phototherapy for psoriasis. But not 100% of the time. As is often the case with Medicare, certain conditions must be met for Medicare to pay for your phototherapy for psoriasis. Below we look at what these are so you know what to expect.
Original Medicare (Medicare Part A and Part B) provides coverage for phototherapy for psoriasis. These policies provide coverage for your light therapy for psoriasis if it is considered medically necessary.
Your healthcare provider must first order the treatment in order for Original Medicare to provide coverage.
Coverage for light therapy for psoriasis is provided by Medicare Part B, as it often takes place in an outpatient setting. Once approved, Medicare Part B covers 80 percent of the costs of light therapy for psoriasis. You will pay for the remaining 20 percent.
Part C and Part D Coverage for Phototherapy for Psoriasis
Medicare Advantage plans (Medicare Part C) also provide coverage for light therapy for psoriasis. They cover everything Original Medicare covers and offer some additional benefits. However, exactly what a Part C plan covers and the out-of-pocket costs will vary depending on the specifics of your plan.
Medicare Part C plans that include prescription drug plans will also provide coverage for medications your healthcare provider will prescribe to you.
Medicare Part D policies provide coverage for medications you need to treat psoriasis. Part D is a prescription drug plan. Like Part C, Part D plans are provided by private insurance companies.
Certain prescription drugs such as Humira also treat psoriasis and other conditions. 99% of both Medicare Part C and Part D plans provide coverage for the medication Humira.
Most Medicare plans restrict the amount of purchase for Humira at once. If you need to purchase a more significant amount of Humira at one time, Medicare may not cover it. You can wait until the period has passed before refilling or contact your plan provider and ask for an exception.
Humira is listed as a Tier 5 drug in the Medicare drug formulary. Tier 5 medications are more expensive than Tier 1, 2, 3, and 4 medications.
Most Medicare plans also may require you to have prior authorization before they provide coverage for this medication. The usage of this medication has to be for medically necessary purposes. You must contact your plan provider to get authorization.
How Much Does Phototherapy For Psoriasis Cost?
The exact cost depends on the exact nature of your treatment. For example, a standard at-home NB-UVB unit costs about $2,600 on average.
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 Lyme Disease Testing?