Utah · Medicare · Skin cancer, dermatology and what Part B pays

Does Medicare Cover Skin Cancer Checks in Utah? (2026)

Utah has the highest melanoma rate in the United States, and among people 65 and older it is 1.84 times the national rate. Medicare will not pay for a routine skin check, but it pays for nearly everything that follows a suspicious spot. Here is where the line falls, what each step cost a Utah patient in CMS's own claims data, and how a Medigap policy or a Medicare Advantage plan changes the bill.

Utah Retirement Income Data Desk

Reviewed by Brian Penner, Retirement income & long-term care planner · Published October 2, 2026

Medicare covers skin cancer, but it does not cover looking for it. That is the whole answer in a sentence, and the distinction matters more in Utah than anywhere else in the country. Medicare Part B pays for “medically necessary doctor services and most preventive services,” in Medicare.gov's words, and its list of preventive services names screenings for breast, cervical, colorectal, lung and prostate cancer and leaves skin cancer off. So a dermatologist's annual “mole check” for someone with no symptoms and no history is not a covered preventive benefit. The moment there is a reason, a spot that has changed, bled or appeared, a prior skin cancer, a referral from your doctor, the same visit becomes a covered diagnostic service, and the biopsy, the pathologist's reading, the surgery to remove what is found and the repair afterward are all Part B services at 20% after the deductible. The rest of this article explains why the line sits where it does, what each step cost Utah patients in 2024 according to CMS's own claims file, how Utah's numbers compare with the nation, and how a Medigap policy or a Medicare Advantage plan changes what you pay.

Why is a routine skin check not a Medicare preventive benefit?

Medicare can add a preventive service to the list it covers at no cost only when the U.S. Preventive Services Task Force, the independent panel that grades the evidence for screening tests, gives the service an A or B grade. For skin cancer the Task Force's most recent recommendation, finalized in 2023, is an “I statement”: “the current evidence is insufficient to assess the balance of benefits and harms of visual skin examination by a clinician to screen for skin cancer in adolescents and adults.” The Task Force is careful to add that the statement “does not apply to persons with a personal or family history of skin cancer” or to “persons with symptoms, such as changes in size, shape, or color of skin growths or irregular moles,” and that clinicians should use their judgment. That is the hinge. A skin exam for someone without symptoms is screening and not covered as prevention; the same exam for someone with a changing spot or a history is diagnosis or follow-up and is covered as medically necessary care.

Two Medicare visits are often mistaken for a skin check. The one-time “Welcome to Medicare” visit and the yearly “Wellness” visit are both covered at no cost, and both produce a written checklist of the screenings you are due for, but Medicare.gov says of each that it “isn't a routine physical exam.” If your provider does examine a spot during that visit and bills for it, Medicare.gov warns that “the Part B deductible may apply if your provider performs additional tests or services during the same visit that Medicare doesn't cover under this preventive benefit.” Our guide to the Annual Wellness Visit versus a physical walks through what that visit does and does not include.

What skin cancer care does Medicare Part B cover, and what do you pay?

Once there is a medical reason, Part B treats skin cancer like any other doctor-delivered care. Medicare.gov's rule for doctor services is one sentence: “After you meet the Part B deductible, you pay 20% of the Medicare-approved amount for most services.” The 2026 deductible is $283. CMS's claims file for 2024 shows what the Medicare-approved amounts actually were for Utah providers, and therefore what the 20% share came to.

Beneficiaries are distinct people with at least one claim for the code in 2024, office and facility settings combined; the approved amount and your share are the Utah office-setting averages (the physician fee is lower in a hospital outpatient department, but the facility then bills its own charge). Your share assumes the Part B deductible has been met and the provider accepts assignment. Denominators are people with Part B in Original Medicare during 2024 (Utah 183,494; national 27,982,142). Medicare Advantage encounters are not in this file. Sources: CMS, Medicare Physician & Other Practitioners — by Geography and Service, 2024 — data.cms.gov; CMS, Medicare Monthly Enrollment — data.cms.gov; Medicare.gov, “Doctor & other health care provider services” — medicare.gov.

A few things the table does not show. The office visit itself is a separate charge with its own 20%. A biopsy generates two bills, the dermatologist's and the pathologist's. Prescription creams used on precancerous patches, such as 5-fluorouracil and imiquimod, are Part D drugs with the copay your drug plan sets, while infused drugs given in a clinic for advanced melanoma are Part B drugs with 20% coinsurance and no cap in Original Medicare, which is the single strongest reason a Medigap policy or a Medicare Advantage out-of-pocket limit matters in a cancer year. Radiation therapy for skin cancer is covered under Part B as well.

How much more skin cancer care do Utahns on Medicare get than the rest of the country?

CMS's claims file counts every service billed to Original Medicare by billing code and by the state of the provider who delivered it, so it can answer this directly for the roughly 183,494 Utahns who had Part B in Original Medicare in 2024. The answer is: a great deal more. 42,920 of them, 23.4%, or about one in 4, had at least one precancerous actinic keratosis frozen or burned off (billing code 17000), against 15.4% nationally; Utah providers billed a further 210,094 services for the second through fourteenth lesions treated in the same visits, and 7,715 Utahns had 15 or more lesions treated at once, a rate 2.04 times the national one. 21,697 Utahns, one in 8, had a first skin biopsy. 7,629, one in 24, had a first stage of Mohs surgery on the head, neck, hands or feet, 1.62 times the national rate, and 768 had a flap repair of the eyelids, nose, ears or lips afterward.

Sources: CMS, Medicare Physician & Other Practitioners — by Geography and Service, 2024; NCI and CDC, State Cancer Profiles — statecancerprofiles.cancer.gov; CMS, Doctors and Clinicians National Downloadable File — data.cms.gov.

Share of people with Part B in Original Medicare who had each service billed in 2024; Utah bars solid, national bars lighter; bars scaled to the largest value. The “any code” rows sum the size and body-site codes for destruction (17260–17286) and excision (11600–11646) of malignant skin lesions, so a person treated under two codes is counted twice. Source: CMS, Medicare Physician & Other Practitioners by Geography and Service, 2024.

Two cautions on reading the chart. The file covers Original Medicare only, so none of the care received by the 269,226 Utahns in Medicare Advantage plans in June 2026 (54.9% of the state's 490,235 beneficiaries) is in it, and it counts people by the state of the provider, so a Utahn treated in another state is counted there. Neither changes the comparison much. Utah runs 1.52 times the national rate for precancerous lesions, 1.21 times for a first biopsy, 1.62 times for Mohs on the head and neck and 1.51 times for destruction of a skin cancer, while excision of a skin cancer is close to the national rate (2.14% vs. 2.09%). Utah dermatologists, in other words, are treating more early disease and more lesions per patient, which is what you would expect in the state with the highest melanoma rate and a long history of sun exposure in its retirees.

How does Utah's melanoma rate compare, county by county?

The National Cancer Institute and the CDC publish a combined cancer registry for every state and county. For 2019 through 2023, the most recent five years available, Utah's age-adjusted melanoma incidence was 43.8 new cases per 100,000 people a year, first among the 50 states and 1.84 times the national rate of 23.8, with about 1,317 new diagnoses a year. Among residents 65 and older the rate is 185.1 per 100,000 against 100.7 nationally, again first in the nation, about 681 new cases a year, and rising at 3% a year against 1.6% nationally. Utah's melanoma death rate, 2.8 per 100,000 for 2020 through 2024 against 2 nationally, is tied for the highest reported, about 85 deaths a year. The CDC's explanation for Utah is the obvious one: more sunny days than the national average, high elevation, and a largely fair-skinned population.

Age-adjusted to the 2000 U.S. standard population; invasive melanoma of the skin only. NCI suppresses counties with three or fewer average annual cases (Beaver, Daggett, Emery, Garfield, Grand, Juab, Millard, Morgan, Piute, Rich, San Juan and Wayne for ages 65+) and does not report a trend where counts are small; rates for counties with fewer than 10 cases a year have wide confidence intervals. All 17 counties with reportable data exceed the national rate. Source: NCI and CDC, State Cancer Profiles, November 2025 SEER and NPCR submissions — statecancerprofiles.cancer.gov.

Washington County stands out. Its rate among residents 65 and older, 335.3 per 100,000, is nearly double the state figure and more than three times the national one, with about 138 new cases a year and a trend NCI labels as rising 11.4% a year. St. George is the retirement destination of choice for people who want sun, and the registry shows the consequence. Summit and Wasatch, the high-elevation ski and lake counties, and Iron County around Cedar City come next. The Wasatch Front counties, Salt Lake, Davis and Weber, run close to the state average and are stable, while Utah County is the lowest of the large counties at 125.8, still well above the nation.

Can you see a Utah dermatologist on Medicare, and do they accept assignment?

With Original Medicare you do not need a referral and you can see any dermatologist who takes Medicare. CMS's clinician file, updated in August 2026, lists 168 clinicians with a Utah practice location whose primary specialty is dermatology. 161 of them, 96%, accept assignment, which Medicare.gov defines as agreeing “to accept the Medicare-approved amount as payment in full for a covered service.” The remaining 7 are “non-participating”: they may take the approved amount case by case, and Medicare.gov explains that they “can charge you more than the Medicare-approved amount,” up to 15% above it, a figure called the limiting charge, and may ask for payment at the time of service. That matters for Medigap shoppers: Plan G pays Part B excess charges and Plan N does not, a trade-off our Plan G versus Plan N guide works through. You can check any doctor's assignment status in Medicare.gov's provider search before you book.

Clinicians whose primary specialty in the CMS file is dermatology, counted once per clinician per city; a doctor who practices in two cities appears under both, so the column does not sum to 168. Nurse practitioners and physician assistants working in dermatology offices are listed under their own specialties and are not included. Source: CMS, Doctors and Clinicians National Downloadable File — data.cms.gov.

The geography is lopsided. Salt Lake County, Utah County and the Davis and Weber corridor hold most of the state's dermatologists; Cache Valley and St. George are reasonably served; and large parts of central, eastern and southern Utah have one or two or none. That is one reason Utah's Mohs surgery is concentrated in about 50 billing providers and why a rural patient's “cost” of skin cancer care includes a drive to Salt Lake City, Provo or St. George. If you are in a Medicare Advantage HMO, add the referral step and the network check; if the plan's dermatologists are two hours away, that is a fact worth weighing during the Annual Enrollment Period.

How do Medicare Advantage and Medigap each handle a skin cancer?

More than half of Utah's Medicare population, 269,226 of 490,235 people in June 2026, is in a Medicare Advantage plan. Those plans must cover everything Part B covers, including every service in the table above, but on their own terms: a specialist copay for the dermatology visit, a copay or coinsurance for outpatient surgery such as Mohs, 20% or a plan-set coinsurance for Part B drugs, prior authorization for some procedures, a referral in most HMOs, and an in-network out-of-pocket limit that caps the year. The limit is the plan's real value in a cancer year; the copays and the network are its cost. Read the Evidence of Coverage line for “outpatient surgery” and “Part B drugs,” not just the specialist copay.

In Original Medicare with a Medigap policy, every one of these services is 20% after the deductible, and the policy pays the 20%. Plan G pays everything but the $283 deductible, including excess charges from a non-participating dermatologist; Plan N pays everything but the deductible, a copay of up to $20 for office visits, and leaves you with any excess charge. There is no network, no referral and no prior authorization, which for a patient who ends up with two Mohs stages, a flap repair and a year of follow-up visits is the whole appeal. The 221,009 Utahns in Original Medicare in June 2026 who have no Medigap policy are the ones with real exposure: 20% of a flap repair is $141.52, 20% of a course of infused immunotherapy is far more, and nothing caps it. Our Medicare Advantage versus Medigap guide lays out the trade-off in full.

A St. George example: one spot on the nose

Consider a 70-year-old woman in Washington County in Original Medicare with a Plan G Medigap policy. She spent 30 years in southern Utah's sun before she retired. At her Wellness visit in September she mentions a pearly bump on the side of her nose that bleeds when she washes her face. Her doctor looks at it, which turns the conversation into a problem-focused visit with its own charge, and sends her to a St. George dermatologist. The dermatologist biopsies it; the pathologist reports a basal cell carcinoma; and because it is on the nose, she is scheduled for Mohs surgery, which takes two stages to reach clear margins and a flap repair the same afternoon. At 2024 Utah office-setting averages, the Medicare-approved amounts look like this: