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Rosacea is a skin condition that causes flushing and, sometimes, pus-filled bumps. There are treatments available that you can get through a dermatologist.
If this is a condition you have and want to treat, a common question many have is, does Medicare cover rosacea treatment?
In this article, we answer that question in clear, plain English. You will also find the average costs of rosacea treatment for those who have to pay out of pocket.
Does Medicare Cover Rosacea Treatment?
The short answer is yes; Medicare will cover the cost of treatment for rosacea. But this is not the case 100% of the time. As is often the case with Medicare, certain conditions must be met for Medicare to pay for your rosacea treatment. Below we look at what these are so you know what to expect.
Original Medicare Coverage of Rosacea Treatment
Original Medicare (Medicare Part A and Part B) provides coverage for rosacea treatment.
Medicare will provide coverage for your rosacea treatment as long as it meets these requirements:
- It is considered medically necessary by your healthcare provider
- The treatment or procedure is FDA approved
If you have Original Medicare, you can also receive coverage for other dermatology services. The key condition these skin treatments must meet is that they are medically necessary. Cosmetic procedures are rarely eligible for coverage.
Your healthcare provider must first order the dermatology treatment in order for Original Medicare to provide coverage.
But which part of Original Medicare covers dermatology procedures and treatments? Is it part A or part B?
Part A vs. Part B Coverage of Dermatology Procedures
In most cases, coverage for dermatology procedures/treatment is provided by Medicare Part B. This is because Part B covers outpatient services. Most dermatological treatments occur on an outpatient basis.
Once approved, Medicare Part B covers 80 percent of dermatology procedures/treatment costs. You will pay for the remaining 20 percent.
Part B provides coverage for dermatology services such as screenings and diagnostic services for hair, nails, and skin conditions. It also 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, Medicare Part B will not provide coverage for them.
Medicare Advantage Coverage of Rosacea Treatment
Medicare Advantage plans (Medicare Part C and D) also provide coverage for rosacea treatment. These plans are required to cover everything Original Medicare covers.
But Part C plans offer coverage for things Original Medicare does not cover. Exactly what each Part C plan covers and how much your out-of-pocket costs are will vary depending on the specifics of your plan.
Part C vs. Part D Coverage of Rosacea Treatment
Medicare Part C plans that include prescription drug plans will also provide coverage for medications your healthcare provider will prescribe to you.
Similarly, Part D plans provide coverage for medications you need to treat rosacea and other dermatological conditions. This is a prescription drug plan. Like Medicare Part C, Medicare Part D plans are provided by private insurance companies.
How Much Does Rosacea Treatment Cost?
The cost of rosacea treatment depends on the kind of treatment you need. Common treatments include topical antibiotic drugs and oral antibiotics.
Other popular options include dermabrasion and lasers. Lasers use intense light to get rid of blood vessels that have gotten bigger.
Antibiotics typically cost around $50-$250 depending on whether you choose generic or brand-name.
Laser treatments usually cost between $250 and $700 per session.
Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage. Always 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 You In Canada?