Last Updated on February 28, 2022 by Anne-Sophie Reinhardt
People looking to see a dermatologist can be confused by the issue of Medicaid’s dermatology coverage. So, does Medicaid cover dermatology?
Medicaid coverage is based on where you live in the United States. This also applies to dermatology as well. However, your State decides how much you will be reimbursed for the services you receive in dermatology.
Medicaid is a state-by-state program. It’s governed chiefly by state laws and not federal laws. Due to the rising incidence of skin problems, the States are now beginning to recognise the importance and necessity of including dermatology services into Medicaid.
What is Dermatology?
Dermatology refers to the diagnosis and treatment of skin and hair conditions. The skin is the body’s largest organ and protects internal organs from injury and bacteria. However, it can become irritated by toxic substances and lead to serious health problems if not treated.
The skin is also an indicator of the overall health of the body. That is why dermatology services are essential in diagnosing and treating many illnesses. Problems with the hair follicles and skin are common. So, nearly everyone will experience a dermatologic condition. Skin problems account for approximately one-sixth of all physician visits.
How can you get Dermatology Medicaid Cover?
Medicaid requires that you get a referral form from your primary care physician to see a dermatologist. However, you don’t need to get an out-of-pocket referral if you want to pay for dermatology services. Instead, you can go straight to the dermatologist to book an appointment.
Your primary care doctor can refer or state that you should see a specialist, and in this instance, a dermatologist. Medicaid uses referrals to reduce costs and verify that you have a legitimate need to see a specialist. Medicaid will not pay for your dermatologic costs if you don’t have a referral. So, you will need to pay the difference out-of-pocket.
However, if the dermatologist is not in the Medicaid network, you might be charged an out-of-network fee. To get a referral from your primary physician, you don’t necessarily need to make an appointment. Sometimes, a simple phone call can get you the referral verification to see a specialist.
Which Dermatologic Conditions are Covered by Medicaid?
You can receive treatment for the following conditions if your state allows Medicaid to cover your dermatology care:
This refers to abnormal skin cell growth caused mainly by direct sunlight exposure. Skin cancer is the most common form of cancer, and there are three types. Recent Medicaid expansions have made it easier to get skin cancer screenings and skincare at a lower cost.
Port Wine Stain Removal
Port-wine stain treatment is a laser operation that removes severe birthmarks that look similar to wine stains. In some states, like Minnesota, this treatment is a mandatory benefit. This means that Medicaid must cover the treatment in all other states.
Psoriasis refers to a skin condition that causes red, inflamed, crusty patches on the skin. These patches are most commonly found on the scalp, elbows, and knees.
You can treat Psoriasis with moisturisers or ointments. However, Medicaid will pay for dermatology costs if you have this condition. Yet you will need to pay your deductibles and any copayments.
Atopic dermatitis (Eczema), causes your skin to become itchy and red. Although it is more common in children than adults, it can also occur at any age.
Under the CHIP (Children’s Health Insurance Program), Medicaid covers children and adults. However, Medicaid will not pay for certain conditions like Acne or Keloids, as they are cosmetic. Furthermore, Medicaid does not cover Botox, chemical peels, and tattoo removals.
How Can You Find a Dermatologist That Accepts Medicaid Cover?
You can use Medicaid’s physician comparison tool to find a dermatologist in your area that accepts Medicaid. Open Medicaid’s portal and type in your State or City. Then, use the keyword “dermatology” to access this tool.
The search results should include dermatologists and clinics that are within 15 miles of each other. This online tool is great because it displays the physician’s performance data such as patient ratings.
Why Do Dermatologists Reject Medicaid Cover?
It is a well-known fact that Medicaid enrollees find it more difficult to see a dermatologist than those with private insurance. Why is this?
Medicaid pays only 60% of the reimbursement costs. The cost of medical support staff, medical premises rent, and utilities should be covered by reimbursement. This does not include the cost of the doctor’s work and time.
When they visit hospitals, dermatologists often bring their own supplies. It can be difficult to find the equipment needed for procedures such as skin biopsies in hospitals.
In Ohio, for example, the compensation for skin biopsy by Medicaid is 47.2 USD. Medicaid does not pay for the equipment and supplies needed to perform a biopsy. In such cases, the doctor provides their services and time for no charge.
Medicaid eligibility to pay for dermatology services largely depends on where you live. Make sure you check with your local Medicaid provider to confirm if your plan covers dermatology services.
If you wonder about Medicare Coverage, you can read our article about Medicare Dermatology Coverage.