FAIR Health Consumer Access

Coverage for Healthy Summer Skin

With the summer heat comes the summer sun. Spending time in the sun feels good, but too much sun can be bad for your skin. It can cause sunburns, sunspots, freckles and wrinkles. Too much sun can also cause skin cancer.

Spending some time in the sun is good for you. It helps your body produce vitamin D and may have other benefits. But according to the American Academy of Dermatology, when sunlight hits your skin, it damages healthy skin cells. And the damage can build up. That’s because sunlight contains invisible ultraviolet (UV) rays. The UV rays can cause sunburn (UVB rays) and affect how your skin grows, causing early aging (UVA rays). Dermatology is the branch of medicine that focuses on skin health. Health insurance coverage for dermatology and keeping your skin healthy in the sun varies, depending on your plan.

Coverage for Summer Skin Care
Sun protection: Wearing sunscreen and covering up with clothing can protect your skin from too much sun. But the health insurance you get through your job or a family member’s job typically won’t cover those things. However, if you have a flexible spending account (FSA) or health savings account (HSA), you can use it to buy sunscreen. Check with your FSA/HSA to see what requirements it has. For example, you may have to buy a broad-spectrum sunscreen (one that protects against UVA and UVB rays) with a sun protection factor (SPF) of 15 or higher.

Skin exams: Most health plans will cover some dermatology services, such as annual skin exams. These can help find any sun damage. According to the National Cancer Institute, if you notice a new or changing mole or other change on your skin, you should tell your doctor. Your doctor might suggest you see a dermatologist to get it checked out. Be sure to check with your plan about whether you need a referral to see a specialist, like a dermatologist. See our article on Types of Health Plans for more information on when you might need a referral. Services at a dermatology office could also include a biopsy to test a part of your skin for cancer.

Skin treatment: If you’re diagnosed with skin cancer, most forms of treatment will likely be covered by your health plan. Treatments can include skin creams, surgery, radiation therapy and immunotherapy. But be sure to check whether your plan requires a prior authorization for any services. This is when an insurance company requires the service to be approved by them beforehand. You can also ask your provider about prior authorization, because often they’ll handle it directly with your health plan.

The type of skin cancer you have could affect your coverage. Most common forms of skin cancer, such as melanoma, basal cell carcinoma and squamous cell carcinoma will be covered for treatment. However, rarer forms of skin cancer might not be as well-covered. Check with your plan. You can also ask your doctor what kinds of treatments are typically covered by health insurance.

If you’ve spent too long in the sun and gotten a sunburn, you’ll probably be able to treat it at home. If your sunburn is severe, your health plan will likely cover any medical treatment recommended by your doctor. This treatment could include steroid ointment, anti-inflammatory drugs and antibiotics.

Sunspots, freckles and wrinkles from sun exposure can be treated by a dermatologist. But treatments for these forms of sun damage are usually not covered by health insurance. That’s because they are considered cosmetic treatments and not medically necessary. However, if you have any sun damage that’s unusual or that you’re worried about, a trip to your doctor to get it checked out will probably be covered under your plan’s benefits. And if your doctor thinks treatment is medically necessary, your health plan may cover that too.

Medicaid and Medicare Coverage for Summer Skin Care
Medicaid coverage varies for dermatology services, depending on the state. Skin cancer screening may be covered under preventive services. And most state plans will cover medically necessary dermatology services. You’ll need to check your state’s Medicaid agency to see what’s covered where you are.

If you have Medicare, it won’t cover routine skin exams if you have no symptoms. However, if you’re worried about something new or changing on your skin, it will cover getting that checked out by a doctor. If you have skin cancer, Medicare Part B covers medically necessary cancer services, such as doctors’ visits. It will also cover surgery to remove the cancer, radiation therapy and chemotherapy drugs. Find a dermatologist near you who accepts Medicare here.