When most people think of plastic surgery they think of facelifts, breast augmentations and rhinoplasties. And while yes, these procedures are considered plastic surgery, they are technically cosmetic surgery.
There are other types of plastic surgery called reconstructive surgery which is geared towards fixing or, “reconstructing”, birth defects, traumas, burns and disease.
Medicare Coverage for Plastic Surgery
Medicare will never cover any, “elective”, cosmetic procedures as elective surgery means the procedure is optional and therefore not considered medically necessary. There are, however some cases in which cosmetic surgery can be considered as medically necessary.
For example, a breast reconstruction, secondary to a mastectomy due to breast cancer, would be covered with your Traditional Medicare benefits.
If the reconstructive surgery is from a medical condition that is deemed medically necessary from a healthcare provider, then your Traditional Medicare benefits will pick up 80% of the cost.
If your reconstructive surgery is performed in a hospital setting, then Part A provides coverage and if your procedure is performed in an outpatient setting, then Part B comes into play.
With Medicare Part B, there is a deductible which is $183.00 and must be met prior to Part B coverage.
Major reconstruction/plastic surgery conditions that Medicare considers as medically necessary:
- Reconstruction to one or both breasts following a mastectomy due to cancer
- To improve functionality (not the appearance) of a body part that has not formed or developed properly
- To make repairs following an accidental injury or trauma
You can talk more to your medical provider about any and all procedures that are considered medically necessary. If you’re having a reconstructive procedure, remember 20% is not covered by your Traditional Medicare benefits, which you will be financially responsible for.
Quick Medicare Review
Medicare is our countries federal health insurance for seniors age 65 and older. Some individuals with certain health conditions can qualify for disability, therefore making them eligible for Medicare at an earlier age.
Medicare comes in 2 major parts. Medicare Part A, which is your hospital benefits and Medicare Part B, which is your outpatient benefits. Both Medicare Part A and Medicare Part B provide 80% coverage of the Medicare allowables. The remaining 20% is left to the beneficiary to pay.
Then there is Medicare Part C, which is an elective, Medicare Replacement Plan, that takes over coverage of your Part A and Part B benefits, but usually comes with policy restrictions.
Medicare Advantage Plans are purchased through individual health insurance companies and over time may end up costing more money. Medicare Part D is a prescription drug plan purchased in order to receive prescription medication benefits.
There is also something called Medicare Supplement Plans that can also be purchased through the private insurance companies. These plans can provide additional coverage for medical costs not regularly covered by the Traditional Medicare benefits.
Cosmetic Surgery vs. Reconstructive/Plastic Surgery
Plastic surgery and cosmetic surgery have different goals. They both achieve to change the look of an individual’s appearance, whereas the overall difference lies within the training, research and the patient end result goal.
With cosmetic plastic surgery, it enhances an individual’s, “problematic area”, changing the body or shape of the area so they find it more aesthetically pleasing.
Plastic surgery on the other hand, involves treatment of the condition(s) that cause an abnormality or deformity of a person’s body or body part, therefore changing the shape or appearance.
Specific goals of cosmetic surgery include aesthetic appeal, symmetry and proportion. Cosmetic surgery can be done on all areas of the head, face, neck and body.
Because these areas are already, “functioning”, properly, the cosmetic surgery performed is considered to be elective. Types of cosmetic procedures include.
- Chin or cheek enhancements
- Breast augmentations
- Breast lifts
- Breast reductions
- Eyelid lift
- Brow lift
- Cheek lift
- Tummy tucks
Plastic surgery differs, as the surgical procedures are specifically designed for facial and body reconstruction due to defects either from birth or from disease, trauma or burns.
Plastic surgery will correct the defective area on the body and reconstruct them to make it look as, “normal” as possible. Types of plastic surgery include:
- Burn victim, repair surgery
- Cleft lip and palate reconstruction
- Upper or lower extremity repair
- Breast reconstruction/Breast reduction (male or female)
- Scar revision surgery
- Skin cancer excision
- Tissue expansion
- Hand and face transplants
- Excess skin removal
Depending on what procedure you’re having done will depend on insurance coverage.
How to Get Additional Help with Your Plastic Surgery Costs
Regardless of what type or reconstructive plastic surgery procedure you may be having, Medicare only covers 80%. The leftover 20% is there left for the beneficiary to pay.
Depending on your procedure will depend on the out of pocket costs. As most surgeries are invasive and also require anesthesia, then factor in the hospital or surgery center costs, the 20% can escalate quickly.
With seniors, every penny coming in and going out is a huge factor on whether or not they have a medical procedure. With living on a fixed income, expensive surgical procedures, especially reconstructive ones, generally are placed on the back burner as they figure it can’t be afforded.
As previously mentioned, there are Medicare Supplement Plans available to assist in covering additional out of pocket costs. Items like deductibles, coinsurance, copayments and other medical expenses can be covered, depending on which Medicare Supplement Plan you decide to go with.
You can get more information on what Medicare Supplement Plans are available to you by contacting us today. You can either call us or fill out the online forms.
We have licensed insurance agents that are ready and willing to answer any health insurance questions you might have as well as provide health insurance quotes. There is never any obligation to purchase, don’t hesitate and contact us today!