Medicare Coverage for Eczema medications fall under Medicare Part D Prescription Drug plans. There are different plans each patient should consider what is most beneficial per their unique condition.
Medicare Part D has different “drug tiers” and certain medications that will be covered for beneficiaries based on what “tier” they fall under. Tier 1-4 should be based on your coverage and your condition.
Each health plan has a list of prescription drugs that will be covered by your insurer. This list is known as a formulary.
The full cost of medications isn’t always covered by your insurance company; medications are covered based on the drug tier they fall under.
The higher the tier, the higher the co-pay will be for the patient. Check the website of your insurer to find what tier your medication falls under.
- Tier 1 – Has the lowest co-payment cost, this tier contains most generic medications and generic topical steroids.
- Tier 2 – Has a higher co-payment cost and contains brand-name drugs that are considered “preferred” by the insurance company due to them being less expensive than others. Medications like Elidel as well as Protopic are in Tier 2.
- Tier 3 – Contains brand name medications that are “non-preferred”. This means higher co-payments for tier 3 medications.
- Tier 4 –Co-payments are the highest. Specialty medications which are medications that have no generic version, nor do they have a lower cost. Dupixent is a biologic drug that often falls under this tier.
Medicare Coverage for Eczema & Phototherapy
Medicare Part B will cover phototherapy as it is considered “more affordable” than other treatments. As some patients will fall under the Medicare Part B guidelines, it will cover 80% of medical costs.
As far as the remainder 20%, you will need to enroll in a Medicare Supplement Plan to have the cost covered, without coming out of pocket.
One of the major qualifications of this treatment, to be covered by Medicare Part B:
If psoriasis or atopic dermatitis/eczema involves the palms, soles, or intertriginous areas this description should include the percent of the affected area involved, and the associated disability.
Eczema: The Rollercoaster of Skin Diseases
What is Eczema?
Eczema is a general term for a chronic skin condition, also referred to as dermatitis, which is swelling of the skin. In most cases it causes dry, itchy patches on various parts of the body.
Once the skin is irritated and scratched, the skin becomes more inflamed. Red patches will begin to swell, causing a rash-like reaction.
Although there are many types of eczema, atopic dermatitis is the most common. Children, as well as adults, can suffer from this skin disease.
Onset can begin later in life where some are born with it and suffer, even as a baby. Some children will grow out of the disease as they get older, but many will have a life-long battle with their skin.
Causes and Flare-ups
The true cause of the skin condition is still unknown. Researchers believe genetics and environmental factors are the reason some children are born with eczema.
Studies have shown some possess a mutated gene that causes the body to not create enough filaggrin.
Filaggrin is a protein that aids the body in keeping a strong, healthy, protective barrier on the top layer of the skin. Without the protective barrier, moisture escapes causing dry patchy spots to appear.
Thus, leaving the skin more vulnerable to infection, as these spots typically crack & become open wounds when left untreated.
A skin flare-up can occur long after a person is exposed to what potentially could have been the cause. Because of the time gap that can happen between exposure and skin flare-ups, it can make it difficult to pin point what particular thing, or things, might be the cause of the irritation.
Common irritants include:
- Environmental factors (dust, pollen, pets etc.)
- Emotional Stress
- Scented soaps and strong fragrances
- Unhealthy diet
- Lack of water
- Certain metals, nickel especially
- Cigarette smoke
- Becoming hot and sweaty causes the skin to feel very itchy
- Cold weather causes the skin to dry out
- In adults, especially women – hormone changes can cause the skin to break out
Eczema is a skin condition that is unique to each person. What may cause one person’s skin to become irritated may not have any impact on another. The good news is there are a number of treatments available to keep the flare-ups at bay.
Living with Eczema
As a child, living with eczema can be frustrating. Children don’t understand why their skin is always so itchy. It can be hard to control the scratching once skin is irritated, until the patient learns what things are causing their skin to flare up.
As an adult the difficulties have been said to range from anxiety, isolation and always feeling like their skin is a constant up and down battle.
Many adults have said it feels like “a fire they can’t seem to put out.” Some tend to become self-conscious about their appearance.
Dealing with Eczema Prone Skin in Older Adults
As we grow older we think we know our bodies so well, eczema, however in older adults may be caused or aggravated by certain medicines we take and/or illnesses we were previously unaware of.
As we grow older, our mobile and stability as well as our cognitive motions may also become impaired; this may cause eczema to flare up in later adult years.
Certain creams, topical treatments (more so, steroid-based creams) can cause the skin to become thinner after prolonged usage.
As eczema is known to break the topical barrier of skin, it is important older patients with this skin disease seek proper treatment and medications. This is affordable without coming out of pocket, under a Medicare Part D plan.
The time and effort it takes to tackle this difficult skin disease can make many feel like eczema controls their life. Parents have to take time from work for doctors’ visits.
Medicare Coverage for Eczema patients may go through a variety of tests trying to pin point the cause, as well as what specific treatment helps the symptoms.
Children can miss days of school due to skin infections being so common when the proper treatment/triggers have not yet been detected.
Some other issues patients suffer from day to day:
- Lack of quality sleep for children, the parents of, as well as adults with eczema.
- Prone to skin infections because eczema untreated can cause the skin to become so dry and cracked, which leads to itchy skin.
- Children struggle with not scratching at their skin all the time in attempt to relieve the itchy feeling. This leaves the skin open and again, vulnerable to infections such as Cellulitis, Staph infections, etc.
- Children’s behavior and mood can be affected.
- Daily life can be difficult, as people struggle to keep their symptoms from flaring up.
- Triggers or causes can vary from time to time, making it difficult to keep the skin calm.
- Learning how to cope with stressful situations and events during a flare-up.
Eczema Treatments & Preventatives
The true cause of eczema is still unknown, and as of late there is no cure. This disease impacts millions of American’s each year.
There are a number of treatments & options for ‘flare up’ preventions. The main trick to keeping eczema from taking over a person’s life is to manage the symptoms.
Here are some of the key points on how to do so.
- First understand what some of your causes or “triggers” for flare-ups are – and avoid them.
- Create a daily skin regimen & stick to it!
- Find professionals who specialize in treating eczema to help find the proper treatment.
- Always watch for signs of infection, as the skin is prone to it.
- Adults can learn how to avoid or cope with stressful situations or life events; either on their own or with professional help if needed.
- Try to avoid scratching or rubbing the dry/irritated skin.
- Luke warm baths followed by much needed daily moisturizing! It’s vital to keep the skin always moisturized.
Treatments will depend on how severe each individual case is. As this becomes a more common disease, more treatments are becoming available.
Prescription drugs, OTC treatments, phototherapy, injectable as well as oral medicines are just some of the treatments.
The most important thing to remember is there are many factors to which can cause eczema to just “pop-up” out of nowhere.
In some cases, patients have grown out of eczema at a young age and never suffer from the disease again; whereas in other cases patients had no eczema spots show up until young adult-hood, or even later in life.
Since there’s so many different cases and factors to consider, many studies are being conducted all over the country in attempts to learn more about this non-curable disease; as well as what can be done to properly treat each individual case.
Get Help Paying for Eczema Medications and Treatments
If you’re a Medicare beneficiary, we’re here to help educate you on all your healthcare options. Whether you’re just aging into Medicare or already enrolled, we’ll make sure you have the best plan that fits your individual healthcare needs.
Get help paying for high out of pocket costs associated with Eczema treatments today. Compare rates for Medicare Supplements by giving one of our licensed Medicare agents a call. You can also compare rates online now by completing our rate form here.