Medical Treatments for Eczema: What is Covered by Medicare?

By Danielle K. Roberts (see bio below)

Eczema, also known as atopic dermatitis, is a condition where a person’s skin can flare up in an itchy, inflamed rash. The rash usually flares up in places that typically stay warm such as elbow creases and behind the knees.

Although the cause of eczema is unknown, we know that eczema isn’t contagious by physical touch nor virally. Likely, factors such as genetics and allergies are the culprit. Often, people who have eczema also suffer from allergic rhinitis and/or asthma.

Eczema can only be managed, not cured. There are many ways that have been proven to help reduce the number of eczema flare-ups, such as avoiding certain stressors, medication, and therapies. Medicare covers each of these medical treatments for eczema differently. There are also treatments, like naturopathy, that are not covered by Medicare.

Medical Treatments for Eczema

Phototherapy is a type of therapy that uses specific kinds of light to treat certain conditions, including eczema. The type of phototherapy used most often to treat eczema is ultraviolet B (UVB) light therapy. This treatment can reduce both itch and inflammation as well as help your body fight infections.

When this medical treatment for eczema is done as an outpatient service, Part B will likely cover it to treat your eczema. However, you can also purchase UVB light panels to use in your home for your phototherapy. If you go this route, your doctor will need to prescribe the panels to you, and you will need to order them from a Medicare-approved durable medical equipment (DME) supplier.

When receiving a medically necessary outpatient service or DME, Part B will pay 80 percent of your costs. You will be responsible for an annual deductible as well as 20 percent of your bill.

Prescription Treatments for Eczema

There are many prescription medications for eczema. Popular types of medications that are used to treat eczema are steroids, antihistamines, and topical antiseptics. For retail prescription medications, Medicare Part D will provide you with some coverage.

Whether your prescription treatment for eczema is covered by your Part D plan or not will depend on your plan’s formulary. The formulary is a list of medications that the plan covers. The formulary also includes information like the tier of medication and utilization restrictions.

Within any Part D plan, there are four stages of payment. The first stage is the deductible. Once you’ve met that, the second stage will be to pay the copay for the correlating tier of the drug. Once you and your plan have paid a total of $3,820 for the year, you will begin stage three, or the donut hole.

During this stage, you will pay a percentage of the drug depending on what type of drug it is. If it is a brand-name drug, you will pay 25 percent, and if it’s a generic drug, you will pay 37 percent. After you and your plan have paid $1,280 during the donut hole, you will move into catastrophic coverage for the remainder of the year. Here, you’ll pay a small percentage, while your plan picks up the majority of the cost of the prescription treatment.

Naturopathic Treatment for Eczema

Although medical treatments and prescription medications for eczema provide relief for eczema patients, many people turn to naturopathic or home remedies for management. Some examples of these are moisturizing often, over-the-counter antihistamines, and avoiding irritants such as certain materials.

Another popular at-home treatment that has been proven to relieve eczema symptoms is wet wrap therapy. This involves taking a bath in lukewarm water, then applying moisturizer and wrapping the affected areas in wet towels or gauze. This therapy works best done three times a day.

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Acupuncture, another naturopathic therapy, is said to help inflammation and itchiness caused by eczema. However, acupuncture is not covered by Medicare. Because Medicare only covers medically necessary treatments and acupuncture isn’t considered medically necessary by Medicare, it isn’t covered at all. This means you would be responsible for 100% of the costs.

Similar to acupuncture, clothing that help soothe irritated skin caused by eczema isn’t covered either. Recently, companies have come out with some clothes made from specific materials that can help to calm eczema symptoms. Again, because these clothes aren’t medically necessary, they won’t be covered by Medicare.

In the end, Medicare will only cover services and treatments that are deemed as medically necessary by Medicare and your doctor.

Bio: Danielle K. Roberts is a Medicare insurance expert who writes regularly for many online publications, including Forbes. A TCU journalism graduate and former magazine editor, she enjoys sharing her knowledge about Medicare, retirement and insurance so that baby boomers can prepare for the costs of healthcare in retirement.