Medicare and Skin Cancer: What You Should Know
Skin cancer is the most common type of cancer. In fact, more people are diagnosed with skin cancer every year in our country than all other cancers – combined (Skin Cancer Foundation).
According to research out of the Department of Dermatology at Beth Israel Deaconess Medical Center, the older population is at the highest risk with at least one in five Americans developing skin cancer by age 70.
Most adults over age 65 rely on Medicare for their health insurance, so we’ll be diving into how Medicare helps pay for skin cancer screenings, exams, and treatments. But first, it’s important to understand skin cancer – is it preventable, and what are the different types?
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Preventing Skin Cancer
Skin cancer is the most preventable cancer (Prevent Cancer Foundation).
Many don’t realize that every time they tan, they increase their risk of getting skin cancer (CDC). So, your first line of defense is limiting sun exposure, staying out of the tanning bed, and using sunscreen. This is called “primary prevention.”
Your second line of defense is examining your skin on a regular basis for suspicious moles or other skin features. A physician or other trained individual can also do this for you. That’s called “secondary prevention.”
But, you likely already know this. The American Cancer Society (ACS) and the American Academy of Dermatology (AAD) have been promoting and sponsoring messages like this for years.
Avoiding too much sun and using sunscreen religiously is your main goal when you’re a child and young adult, but by the time you’re 65, much of the damage has already been done.
While you want to keep things from getting worse, the majority of what you can do now is keeping an eye out for lumps, bumps, spots, sores, or marks on your skin that are new or changing. They can be pink, red, brown, black, and even yellow-ish. If you notice anything at all, you need to see a doctor.
Nearly all skin cancers can be treated effectively if you catch them early (American Cancer Society).
Types of Skin Cancer
There are many types of skin cancer, but the three researchers and physicians focus on the most include melanoma, basal cell carcinoma, and squamous cell carcinoma. Basal cell carcinoma and squamous cell carcinoma are often lumped together and are called nonmelanoma skin cancer.
These are the types of skin cancers screenings are designed to find and treat early.
Melanoma is the least common type of skin cancer, but it’s also the most fatal. It accounts for less than 5 percent of reported cases but about 80 percent of skin cancer deaths. Melanoma is the most common in white men over age 65.
If you can diagnose melanoma when it’s still thin and hasn’t spread much, your odds of surviving about 5 years are really good (about 95%). When it spreads, your chances decrease to 58%, and when it gets severe, they drop to only 13%.
That’s why skin cancer screenings are so critical!
Nonmelanoma skin cancers are the most common, with about 1 million new cases each and every year. Anyone can get skin cancer, but older white people who have gotten way too much sun in their life are at the highest risk. A poor immune system and cigarette smoking also increase your risk factor.
While nonmelanoma skin cancers are very common and grow slowly, they can still cause death if you neglect them. If you treat them with surgical removal, it’s highly curable.
Again, get screened! The question is, does Medicare cover these screenings and possible surgical removals?
Medicare and Skin Cancer
Medicare does offer some coverage for skin cancer. In fact, dermatologists billed Medicare for about 28 million procedures in 2013 (JAMA Dermatology). The most common procedure was destroying precancerous lesions.
As a general rule of thumb, Medicare helps cover items and services that are deemed medically necessary. However, there are always some exclusions, so let’s go over how Medicare covers skin cancer screenings and treatments.
Skin Cancer Screenings & Body Exams
If you have no symptoms of skin cancer, Medicare doesn’t cover skin cancer screenings. That’s been a pain point for providers across the country for years because we know just how critical preventive exams can be in finding and treating deadly skin cancers.
Many providers recommend an annual body exam – especially if you’re higher risk – to check for any new moles or growths, but Medicare won’t be paying for it. Those who are at a higher risk for skin cancer have some of the following attributes (CDC):
- Fair skin
- Skin that burns, freckles, reddens easily, or becomes painful in the sun
- Blue or green eyes
- Blond or red hair
- Lots of moles
- Family history of skin cancer
- Personal history of skin cancer
- Older age (65+)
Medicare will pay, however, if you’re worried about a mole or new skin growth and you initiate a visit with your doctor.
Plus, if you’re seeing the doctor for something else and they notice a possible skin cancer growth, they can extend the visit to investigate more, and Medicare might pay the physician a little more for the visit.
If your doctor refers you to a dermatologist to take a deeper look, Medicare covers that referral visit.
Surgical Treatments for Skin Cancer
The most common treatment for skin cancer is surgery. Basal or squamous cell skin cancers (nonmelanoma) are often removed via electrodesiccation and curettage (ED&C), surgical excision, or Mohs surgery, also called Mohs micrographic surgery (MMS). The skin and surrounding tissue may also need to be reconstructed.
You can read more about each skin cancer treatment method over at Perlmutter Cancer Center.
Interestingly enough, none of the surgical treatments for skin cancer are listed specifically in Medicare’s “What’s covered” app. Skin cancer screenings and treatments are also not specifically mentioned anywhere on Medicare’s official website or in the Medicare & You handbook.
However, rest assured that most skin cancer treatments are covered by Medicare.
A team of doctors, including several dermatologists, did a thorough review of nonmelanoma skin cancer treatments in 2011. They wanted to see how much private practices were being paid for the various forms of skin cancer treatment.
These researchers confirm that Medicare covers the treatment of most nonmelanoma skin cancer.
ED&C is billed to Medicare based on its size and where it’s located on your body. For example, a tumor located on your trunk or extremity is paid at a lower rate than one located on your head or neck (generally speaking). Either way, Medicare does cover it.
Surgical excision is also covered, and it pays quite a bit more than ED&C, and rightly so. Again, larger tumors are more complex to remove, so Medicare pays more for that procedure, even over $1,000 in some cases (depending on where it’s located).
Finally, MMS, or Mohs surgery, is covered by Medicare. Medicare pays the provider for each stage.
Additional services are also covered by Medicare, including skin drafts, skin transfer, repairs, and medications like Vicodin and Keflex.
Medicare also pays for a follow-up visit two months after the procedure.
When it comes to the treatment of melanoma, you may be looking at radiation therapy and chemotherapy in addition to surgery, all of which Medicare covers.
Your Costs After Medicare Pays for Skin Cancer Treatments
Your costs will vary depending on what coverage you have.
Original Medicare with a supplement
If you have Original Medicare and a Medicare Supplement, you will have no or almost no out-of-pocket costs for any treatment that’s Medicare-approved:
- Plan F: $0 out-of-pocket costs
- Plan G: you will be subject to your $198 deductible as of 2020; after that, you pay nothing
- Plan N: you have the $198 deductible as of 2020, and you have a copay of up to $20 for some office visits; other than that, you pay nothing
There are other Medicare Supplement plans, but these three are the most popular.
Original Medicare only
If you do not have a supplement and only have Original Medicare, you will have some out-of-pocket costs, which can be significant if you need surgery.
For services done in a hospital, you’ll have the $1,408 Part A deductible as of 2020. That deductible can and does change each year, which is why we specify the 2020 amount.
For services done in an outpatient setting, like the dermatologist’s office, you will need to meet the $198 Part B deductible, and all services have a 20% coinsurance. That coinsurance is what can be pretty scary if you need surgery.
If you have a Medicare Advantage plan, everything gets a bit tricky for a few reasons:
- Every plan is different, though all Medicare Advantage plans must cover at least what Original Medicare does
- You have to see providers in your network; if you don’t, you’re either not covered at all, or you pay a higher out-of-network fee
- MA plans are managed care plans, meaning the plan is going to exhaust all of the lowest cost treatments first, so the treatment recommendation from your doctor may not be approved by your plan
As long as your provider is in your Medicare Advantage plan’s network and you’re fine with the managed care component, your MA plan should help cover the costs of treatment, though you will definitely have out-of-pocket costs like the deductible, copays, and coinsurance.
If your Medicare plan has any kind of cost-sharing involved, such as coinsurance, your costs will vary depending on the lesion size and location. Most surgical excision Medicare billing codes seem to follow this pattern:
- One price for 1.1-2cm
- One price for 2.1-3cm
- One price for 3.1-4cm
- One price for over 4cm
For Mohs surgery, it’s one price per stage, no matter the size.
See a Dermatologist Who Accepts Medicare
Unless you want to self-pay, you’ll need to see a dermatologist that accepts Medicare assignment. If the dermatologist does not accept Medicare, you won’t be able to use your Original Medicare or Medicare Supplement insurance.
You can use Medicare’s Physician Compare tool to see if the dermatologists in your area accept Medicare.
If you have Medicare Advantage, you’ll need to take that a step further by only seeing a dermatologist in your network. You also may need to get a referral from your primary care physician before the plan will pay for your dermatology care.
Sometimes, it’s worth forfeiting your Medicare benefits to see the dermatologist of your choice, even if they don’t accept the insurance you have. Many doctors offer discounted rates to people who choose to pay out-of-pocket, so simply ask.
If you believe a certain provider has superior credentials or simply offers a higher level of care, it may be worth paying extra if you can afford it.
Getting Financial Help for Skin Cancer Services
As we mentioned earlier, preventive skin cancer exams are not covered by Medicare. Medicare will only step in to help if you have a concern about a new mole or growth, even though annual body exams are encouraged by physicians.
If you want to get an annual body exam but are worried about the cost, you have some options.
Ask for discounts
First, ask your dermatologist if they offer a discount for paying out of pocket.
Physicians of all kinds, dermatologists included, offer discounts when they don’t have to deal with insurance. Billing insurance is often a paperwork and logistics nightmare with one too many rounds of back-and-forths. Being able to sidestep that whole ordeal is worth giving a discount!
That’s also why many physicians in a variety of fields offer an even steeper discount for paying cash upfront. For example, Dr. Susan Parr, Au.D, Owner of Parr’s Pro Hearing, explains at her family-owned practice, she offers 40% off medical testing to patients who pay and do not utilize insurance.
Physicians know they’re getting paid, and they don’t have to spend money and resources on billing and perhaps even debt collection.
Seek a low-cost or free clinic
If the discounted offer is still out of reach, consider a low-cost or free clinic. The American Academy of Dermatology offers several sources for finding a clinic near you:
- Find a clinic - National Association of Free and Charitable Clinics
- Find a health center - U.S. Department of Health and Human Services
- Free/Low-Cost/Sliding-Scale Clinics - Needy Meds
Consider a cancer policy
Finally, consider getting a Cancer Insurance policy. Most policies don’t actually cover skin cancer other than malignant melanoma, so please read the exclusions if you want skin cancer coverage. Out of the companies we represent, Cigna is the only one that offers benefits for all types of cancer – internal, malignant melanoma, and other skin cancers.
Getting a Cancer Insurance policy is something you have to do proactively, however. You cannot qualify for Cancer Insurance if you’ve had cancer in the past 10 years.
The Cigna plan we offer is a lump sum plan, meaning you choose your benefit amount, and if you’re ever diagnosed with cancer, you are paid a lump sum. For example, say you select a $20,000 benefit. If you are diagnosed with cancer, you will be sent a check for $20,000 that you can use for anything from treatment to travel costs.
We recommend a Cancer Insurance plan to nearly every client we see as cancer is so common and the coverage is so affordable. For example, a 65-year-old in Texas would pay just $32 per month for a $10,000 lump sum benefit.
Any kind of cancer is scary, even if it’s a type that’s low-risk like many skin cancers or prostate cancer. A cancer diagnosis is a complete shock to the system, and you’re not only worried for your health, but also for your finances.
While you may have to foot the bill for an annual body exam, it’s well worth taking the preventive measure in case you do find a deadly form of skin cancer like melanoma. If you notice anything concerning, Medicare will step in to help.
A Medicare Supplement ensures you have very low or even no financial risk, and a cancer insurance policy will pay you a lump sum upon being diagnosed. Just be careful with which company you choose, as most exclude skin cancers. You’ll also need to purchase cancer insurance proactively since you won’t qualify if you’ve had cancer in the last 10 years.
Navigating Medicare and skin cancer can get complicated, but our Medicare Allies family is here to help you along the way.
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