Transcript (Psoriasis and Medicare)

Introduction

Psoriasis is more than dry, irritated skin. It is a chronic immune-related condition. This can lead to sore, itchy skin patches, joint issues, and problems affecting the scalp, nails, hands, and feet.

Medicare can help with psoriasis prevention, diagnosis, treatment, recovery, and medications. Before we get into psoriasis coverage, it helps to look at what Medicare covers overall. Part A covers medically necessary inpatient hospital stays and skilled nursing facility care. It also covers hospice and some home health services. Part B includes doctor visits, preventive services, durable medical equipment, and outpatient care. Part D generally covers prescription drugs you get from a pharmacy.

Medicare A, B, C, and D can include co-insurance, co-pays, and deductibles.

In this video, we’ll walk through psoriasis prevention, diagnosis, treatment, recovery, and medications.

Prevention

Medicare Part B covers most preventive services, including a Yearly Wellness visit. Those visits may support a psoriasis prevention plan.

There is no guaranteed way to prevent psoriasis, but flare management can help. Prevention steps include avoiding known triggers, managing stress, and treating infections.

Psoriasis is linked with inflammation in the body and may be associated with psoriatic arthritis, heart disease, diabetes, obesity, and depression. Psoriasis is not contagious.

Diagnosis

Doctors typically diagnose psoriasis by examining the skin, scalp, and nails.

They may ask about symptoms, joint pain, and family history.

A skin biopsy is sometimes necessary to exclude other skin conditions.

Medicare Part B covers medically necessary doctor visits, dermatologist visits, diagnostic testing, and skin biopsies, subject to a deductible and 20% coinsurance. 

Treatment
Treatment depends on severity, location, and symptoms. For some people, psoriasis is mild and manageable with creams. Scalp psoriasis may need medicated shampoos. More widespread psoriasis may need phototherapy. Phototherapy means supervised medical light treatment. CMS has a national coverage determination for psoriasis treatments. It recognizes covered conventional treatments, including topical steroids or other drugs, ultraviolet light therapy, and coal tar alone or with ultraviolet B-light, known as Goeckerman treatment. CMS also states that psoralen plus ultraviolet A light, called PUVA, is covered for intractable, disabling psoriasis only after the condition has not responded to more conventional treatments.

Recovery

Psoriasis usually needs follow-up appointments for monitoring progress, potential side effects, and infection risk. Psoriatic arthritis can damage joints if left untreated. Medicare covers medically necessary rheumatology visits, imaging, lab work, physical therapy, occupational therapy, and medications.

Medications

Moderate to severe psoriasis may require oral medicines, self-injected biologics, or provider-administered injections or infusions. Prescription drug coverage varies by plan rules, tiers, formulary, and pharmacy network. A formulary is a drug list covered by your Part D plan. A drug may require prior authorization, step therapy, and quantity limits. Part B often covers outpatient drugs given in medical settings. In most cases, this involves drugs given via injection or infusion, and vaccines for prevention.

Medicare Advantage

With Medicare Advantage, additional rules come into play. All plans must include Medicare services; however, the guidelines can change. Network use, referrals, and prior authorization may affect access. Medicare Advantage plan rules can also affect costs and timing. Some plans may offer extra support for psoriasis treatment. These services can vary by plan and location. Phototherapy or biologic drugs may need approval first.

Final Thoughts

Psoriasis is common and treatable. Psoriasis is a chronic immune-related disease, not just dry skin.

Medicare may cover medically necessary diagnosis and treatment, including dermatologist visits, biopsies, phototherapy, and certain medications. Early action keeps treatment simpler and often less costly. Many people discover a new normal when they live with the challenges of psoriasis.

This includes hobbies, travel, and the simple pleasures of life.