Medicare Coverage for Plastic Surgery

Medicare coverage for plastic surgery is likely in medically necessary situations. If the surgery is cosmetic, you pay out of pocket. If the surgery is essential, Part B pays 80% of the cost after you meet the deductible. However, if you just want to make changes to looks, you pay out of pocket.

Does Medicare Have Coverage for Plastic Surgery?

Coverage for plastic surgery for treatment or repair is likely. This can include repair after an accident or for the treatment of severe burns. Some therapeutic surgeries that serve a cosmetic change may be allowable.

Let’s say Sally has breast implants that prevent breast cancer treatment. Well, Part A can help with costs in an inpatient setting. If the procedure is done in an outpatient setting, Part B covers 80% of the costs. For the lowest cost, go to a doctor that takes Medicare.

Does Medicare Cover Breast Reduction?

Medically necessary breast reduction has coverage by Medicare. However, cosmetic changes won’t have coverage.

Let’s say you’re an older woman with back and neck pain due to large breasts. Also, a reduction can improve posture and breathing.

Breast reconstruction surgery after cancer can be important. With only Medicare, surgery still has out of pocket costs. You pay out of pocket on deductibles and 20% of services. A Medigap plan can cover the gaps in coverage.

Qualifying for a reduction means symptoms for at least 6-months and trying non-surgical options to no avail. When it comes to reconstruction, Medicare covers breast prostheses if you have a breast cancer mastectomy.

Does Medicare Cover Breast Reconstruction After Lumpectomy?

Insurance helps pay for the cost of breast reconstruction surgery after mastectomy or lumpectomy. This can be done right away or years later.

Medicare will never cover an elective surgery; however, when a doctor deems it a necessity, they will pay a part. If you believe your breast reconstruction surgery should have coverage and medicare denies, you can file an appeal.

Does Medicare Cover Liposuction?

Medicare covers liposuction that’s medically necessary. The terms for weight loss surgery are extensive. An abdominoplasty, or tummy tuck, that meets certain standards will have coverage.

An example of a scenario where Medicare will cover the costs of liposuction is if you have lipedema. You need a doctor to write a statement about why liposuction is essential for treatment.

Does Medicare Cover Skin Removal Surgery?

Dropping weight can have a downside; such as rashes or infections from extra skin. If you suffer from excess skin after weight loss, Medicare covers skin removal. Excess skin removal may not be the stage of weight loss you foresaw; however, insurance can help pay for the service.

For approval, you need to meet all of the following:

  • Stable weight for 6-months before surgery
  • A skin condition that threatens the health of your skin
  • Excess skin that impacts daily movement
  • BMI must drop at least 5 points

Medicare covers panniculectomy when it’s a medical need. This is the removal of the pannus. There is no rule to define cost or coverage prior to plastic surgery. In some cases, you pay first and get a reimbursement. Any serious need for the removal of skin has coverage. If excess skin makes your daily life tough, talk to your doctor.

Does Medicare Cover Skin Tag Removal?

Medicare will reimburse skin tag, flat wart, wart, and seborrheic keratosis removal in special situations. This means the problem area needs to bleed, cause pain, have swelling, or be harmful. Talk to a dermatologist about options for your skin.

If insurance won’t pay any portion, the doctor may have a finance plan. Part B will help pay for some of the costs when you see the specialist. Depending on your plan, you might not need a referral.

Does Medicare Cover Rhinoplasty?

Medicare will only cover rhinoplasty surgery if its need stems from a mishap; or, if the surgery improves bodily function. Rhinoplasty surgery fixes the septal bone.

Those that have septum deviation along with a large, misshapen, bent nose may have insurance pay a portion of costs. If you want the surgery for image goals, coverage won’t be likely.

Medicare covers when functional issues are present. Many people mix rhinoplasty with other nose surgeries.

For example, a broken nose can have repair from an open reduction nasal fracture. Also, a septoplasty can solve breathing issues.

If you’re having problems with your nose, talk to your doctor about the best choice for you.

Does Medicare Cover Blepharoplasty?

Medicare covers upper eyelid surgery when the eyelid drops below the normal level, hindering sight. Also, if the cornea is swollen or if the skin relaxes excessively due to lack of elasticity.

Lower eyelid surgery is only available when the cornea is swollen. To get the coverage you must have a doctor record showing the visual disability, a field test must prove 30-degree blocking, and the doctor must take pre-op photos.

Does Medicare Cover Facelift?

A facelift won’t normally pass as medically vital. If you want a good deal on a facelift, talk to your doctor about a finance option.

What is “Medically Necessary” Medicare Coverage for Plastic Surgery?

To have insurance pay part of the bill, it must be vital. When the procedure is merely for looks, the government isn’t going to help fund the cost.

So, if you have a tough life due to excess skin or severe burns, expect coverage. However, if you want bigger lips and thinner thighs, you may be on your own paying for the costs.

Now, in some cases, Medicare pays some of the costs for Botox. This is in cases where it’s for the treatment of headaches or other needs. If you think a plastic surgery procedure will pass for approval, talk to your doctor about options.

Does Medicaid Cover Plastic Surgery?

Many beneficiaries have both Medicare and Medicaid. In this case, Medicaid is a state plan and each state will cover differently. People in some states will have benefits from both programs, others may only receive help through Medicare.

To have coverage, documentation is vital. Records show proof of medical need. If your procedure isn’t a definite need, expect a claim denial. Talk to your insurance about company-specific rules prior to surgery.

Does Medicare Advantage Cover Plastic Surgery?

Medicare Advantage plans have various rules in each area, talk to the company about plan costs. Cosmetic surgery doesn’t have coverage because it’s for image gains. However, plastic surgery fixes damage or disease.

Advantage plans must pay at least as well as Medicare. So, if you receive a denial, file an appeal through the advantage plan. Although, without medical proof, nobody will cover.

How to Get Medicare Help for Plastic Surgery Costs

Those with Medigap have approval if Medicare grants the claim. However, a denial means you pay 100%. Medigap plans cover the out-of-pocket costs you normally pay. This coverage can save you money in the long run.

Give one of our agents a call at the number above to start. If you can’t call now, fill out an online rate form to find the best rates in your area today!

We can help you determine eligibility, enroll, and walk you through any issues in the future. This can be an easy process with the help of one of our brokers. Save time and money by trusting us to walk you through all your insurance needs.

Jagger Esch

Jagger Esch is the Medicare expert for MedicareFAQ and the founder, president, and CEO of Elite Insurance Partners and Since the inception of his first company in 2012, he has been dedicated to helping those eligible for Medicare by providing them with resources to educate themselves on all their Medicare options. He is featured in many publications as well as writes regularly for other expert columns regarding Medicare.

53 thoughts on “Medicare Coverage for Plastic Surgery

  1. I just recently had baractric sleeve surgery and medicare covered. Does medicare cover saggy skin removal after the weight loss?

    1. Cindy, Medicare will not cover cosmetic surgery, even if it was a result from a Medicare covered service.

  2. I have lost 75 lbs and I have saggy skin everywhere a lot in my arms stomach(along with the C-section and hysterectomy) my face sags n is causing my nose to collapse when breathing my stomach is starting to get rash in the folds would Medicare cover plastic surgery for my stomach and face??

    1. Mona, typically Medicare does not cover any kind of plastic surgery for loose skin. However, it seems you might be having additional health issues due to this loose skin. I recommend speaking to your doctor about what procedure would be best for you and contacting your local Medicare office to discuss coverage options.

  3. I had surgery to remove a carotid body tumor and it’s come back. The surgeon cut into nerves that were in the wrong place, leaving me with 3-4 mm ptosis in my eye that I can barely stand to look at. I have to put on a ton of eyeliner to try to hide it but it looks horrible in photos and it gives me awefull anxiety. Would Medicare pay for surgery to fix that ?

    1. Jana, unfortunately Medicare does not typically cover any cosmetic procedures. However, it would be best to speak with your doctor for clarification on this procedure.

  4. Will Medicare give any reimbursement for abdominoplasty to repair diastasis recti for treatment of chronic low back pain?

    1. Hi Donna, thank you for reaching out. Unfortunately, Medicare does not cover Diastasis Recti repairs or abdominoplasty as it is a cosmetic procedure not proven to treat lower back pain.

      1. Hello Jagger,
        What about having a ventral hernia above the navel repaired along with panniculectomy post gastric sleeve surgery and substantial weight loss with a weight loss to goal and steady weight for 18 months? The surgeons also want to fix /reduce/remove an old scar that has adhesions close to the hernia causing discomfort.

      2. If these procedures are deemed medically necessary then they would be covered by Medicare. However, often, cosmetic surgeries are not considered necessary and will not be covered by Medicare. It is important to speak with your doctor about the necessity of the surgeries.

  5. Hello my mom has Medicare and needs her breast implants removed due to the fact that one of them bursted.
    (They have 20+ years already)
    She would like to know if Medicare will cover reconstruction so that her boobs aren’t left looking horrible.
    We keep telling her they won’t do that but maybe with a Medicare expert she might finally believe us.

  6. In 2008 I had a gastric bypass(medically necessary surgery) with few complication at later dates. 2012 I had to have an emergency gall-bladder surgery. The Dr who performs the surgery stated my gall bladder had completely disentigraded and was the worse he had ever seen and 2014 I had to have another surgery this time a complete hysterectomy. Once again apparently my condition warranted a comment in that once again my reproductive system had disentigraded. It seemed as if I was disentigrading from the inside,out. Because that surgery I developed a surgical hernia, and in 2015(to the day on 2014 surgery)this surgery to remove hernia included a tummy tuck.. the tummy tuck was blotched leaving deformity and continue pain and numbness.I have both Medicare Advantage and
    Medicaid. Will they cover the cost to have the tummy tuck repaired? This deformity has lead me to seek professional help because of depression in 2016.

    1. Hi Tina. If your doctor says the surgery is medically necessary then Medicare will cover it. However, Medicare Advantage & Medicaid have their own guidelines. You would need to reach out to your local Medicaid office and your Medicare Advantage carrier directly to find out if they will cover the procedure.

  7. I have stage 4 Lipedema. Could you please direct me to the section in, Medicare National Coverage Determination, where they say liposuction can be covered for lipedema patients? (Southern California LCD would be great too).

    I am currently in a very hard appeals fight with my HMO Advantage plan, and I would like to show them this documentation.

    I won a Fully Favorable decision after a de novo review from the ALJ. My insurance appealed it to MAC (Medicare Appeals Council). MAC lost all the paperwork, had both parties resubmit. In May, MAC vacated the original ALJ decision, (because MAC wasn’t sent the complete EOC). MAC has sent my case back to the same ALJ court for them to make the decision, again, (this will be a final decision). My case has been in MAC for over a year.

    1. Hi Pam. Unfortunately, once you enrolled in an HMO plan you left Original Medicare. It’s up to the Medicare Advantage carrier if they will cover liposuction. They can now choose to deny the treatment if they feel it’s not medically necessary, even if your doctor says it is. If your EOC does not say it’s covered, then it won’t be covered.

  8. I have had several hernias (some reoccurring) down the center of my abdomen, where I had surgery as a baby to fix a bowel blockage in 1978. It has always been very tight in that area, and expanding my diaphragm became more difficult over time. After joining the military, I diagnosed with Diastasis Rect and developed hernias along my midline (umbilical, epigastric, several incisional) but the doctors have me terrified that Medicare will deny coverage because the scarring along my midline prevent them from protruding as the normally would, so it won’t “look” as serious as it is. There is also something called plastering which is causing significant pain in my abdomen as well. What outcomes should I expect when the doctors submit everything to Medicare for payment?

    1. Hi Albert. For this scenario, I would recommend submitting a prior authorization form to make sure Medicare will cover it. As long as your doctor gets all the documentation completed, including a treatment plan, and says it’s medically necessary, Medicare should cover it. Your best option is to get Medicare and your doctor on the phone with you at the time same so you don’t end up playing middle man.

  9. Hi. I’m having reoccurring accesses under my abdomen for over 10 years now. My surgeon just told me that it would be best for a full tummy tuck which will be covered by my insurance. My question is I also have then under both my breasts, inner thighs and under axillias. Could those areas be covered by my insurance if needed.

    1. Hi Elizabeth! Yes, if your doctor feels its medically necessary to remove them from other areas of your body, Medicare will cover it.

  10. Hi, I am looking at getting a tummy tuck for a few reasons. To correct diastasis recti that is causing Incontinence, back pain and a hernia. Would this be covered?
    Thank you.

  11. I am 69 yrs of age and on Medicare and I have decided to try to lose weight without surgery and I already have a hanging belly, arms and neck. I currently weigh 182lbs and 5′ in height and want to lose around 30 to 40 pounds for my health. I can maintain that loss, but I know if I go lower I would have trouble maintaining that. I have heart issues and even though this is a smaller weight loss than those with weight loss surgery this would help my health immensely. After this loss, I know my belly, neck and arm skin will hang even more would this be something Medicare would pay for and if so before starting a weight loss diet do I need to see my doctor and be under his guidance during the diet phase so it would be documented or am I just out of luck. If doing on my own and it doesn’t qualify for reduction surgery then I need to have weight loss surgery just to qualifty?

    1. Hi Denise! These are all questions that you would really need to ask your doctor. The rule of thumb is if your doctor says the skin removal is medically necessary then Medicare will cover it. If it’s not medically necessary, Medicare will not cover it.

      1. I had bariatic surgery over 14 years ago and I have lost about 120lbs and have maintained it. I am 5/4 about 162 and i have a lot of sagging skin. I sweat and have to appy powders and wipes to keep fresh and stop chaffing. I dont know what the process is to get medicaid / medicare to help with panniculectomy.

        Please advise.

      2. Hi Cherisse! You would start by speaking to your doctor. If your doctor says the panniculectomy is medically necessary, they will have the documentation needed to present to Medicare to get it covered.

  12. I have a complication of cervical dystonia caused as a complication from a previous neck lift cosmetic surgery. Does Medicare cover botox treatments for this

    1. Hi Janice! This would be dependent on if your PCP says it’s medically necessary or not. The Botox guidelines from Medicare are constantly being updated. Hoping on a call with your PCP and Medicare at the same time may be your best option to determine if they will cover it.

  13. Hello
    I truly appreciate the time that you have taken to write this article, because I have been living with health problems for a very long time associated with my excess skin following gastric bypass surgery, and I thought that I had no hope since I do not have the money to pay to have this removed if I am paying the entire bill. If I can get coverage of even a portion of the bill that will be tremendously helpful. My question is this- how do I even start the process? I need to find a new GP in my new town. Will my new GP begin the Medicare approval process for the excess skin removal? Do I need to request the records from all of my former physicians myself? I have been able to keep my weight stable for more than the required 6 months. Thank you for your time.

    1. Hi Jennifer! So happy you found the article helpful. Your GP would either start the approval process or send you to a specialist to begin the process. You would for sure need to get all records from your former physicians that would be relevant to the surgery. What parts of Medicare do you have now? Do you have any supplemental insurance such as Medigap?

      1. Thank you so much for taking the time to reply. I have Medicare parts A and B, as well as part D prescription coverage.

      2. Okay, so that means you would be responsible for 20% of the cost under Part B. You would also be responsible for the Part B deductible.

  14. I have lost 110 pounds i have alot of skin under my arm thats heavy and arms hurt when lifting to comb hair or other things will medicare help with this

    1. Hi Millie! If your doctor says skin removal surgery is medically necessary, then Medicare will cover it. Your best option is to reach out to Medicare directly while you’re with your doctor to see what documentation they would require.

  15. I am 66…. and my breast cancer implant has shrunk to an a cup and my natural breast is a c plus. Cant I get them balanced out by Medicare?

  16. I am 31, had 4 c sections, also have had excesions for scar tissue. I have a very bad pouch that gets raw in the summer, my bladder is poking through my abdominal muscles, and my has a bulging disc, a hiatal hernia, and incontinence. I have tried exercise, dieting, core strengthening, abdominal binders, even corsets. It hurts to use the bathroom. It hurts to lift, my hips constantly give out. Someone suggested an abdominoplasty (sp?) I know it’s known as a tummy tuck otherwise to tighten up the abdominal muscles but my old GP wouldn’t even hear me out. She said that if she had to suffer with the aftermath of giving birth then I was fine. She had one baby in the early 80s and is super fit. But I have a new GP that I click with and have an appt with her to see what else we can do about the bladder issue. I am on SSI for disability and have medicare. Is there even a slight chance this may be covered? I had the idea completely shunned as I feel this is just how I naturally look now and was a little proud of the mom body since I had rough pregnancies but considering all the pain I am struggling with, I am desperate for relief. I miss running around and playing with my kids and lifting things. Evening stopping over to garden has become mortifying and painful. Is there a chance that this will be covered? Thank you!

    1. Hi Katie! I’m so sorry you’re struggling with this. The good news is, as long as your GP says it’s medically necessary, Medicare will cover the surgery. There are scenarios where this type of surgery, including bariatric surgery, is considered medically necessary. Talk to your doctor about this, they will know what documentation is needed to give Medicare to have it covered. I hope this helps and I wish you the best of luck!

  17. Howdy Lindsay, I’m looking for help to find a doctor who can help me with extra ski ,hanging from my belly. I have no idea, where to start. I’m soon to be 60 years old, the skin is from pregnancies early inlife. I get raw more so in the summer or warmmonths and it’s really painful. Where would istart to possibly get this taken care of?? Thanks Sally

  18. Hi Lindsey! I had gastric sleeve surgery three years ago & have lost 112 pounds so far. My goal is to lose 50 more pounds. My question is: will Medicare cover skin removal for my belly, breasts & my “wings” on my arms? I get yeast infections under my breasts & belly & understand that this be covered. What qualifications are needed for skin removal for my “wings” left on my upper arms?

    1. Hi Colleen! As long as your doctor says it’s medically necessary to remove the extra skin, Medicare will cover it.

  19. I know that Medicare will authorize a tummy tuck if medically necessary, but does it also cover excess skin on the arms or back?

    1. Hi Colleen! Yes, Medicare will cover excess skin removal as long as it’s medically necessary. If the removal of the excess skin is not considered medically necessary, then Medicare won’t cover it.

  20. Will Medicate + Supplement F cover a rhinoplasty as a result of excessive cancer lesions on the nose?

    1. Hi Julianne! If your doctor says the rhinoplasty is medically necessary, then Medicare will cover the surgery.

  21. Medicare covers liposuction for lipedema that’s considered reconstructive and medically necessary. You will likely have to appeal a denial multiple times. You need a doctor to write an expert opinion letter explaining that the liposuction 1) restores to a normal appearance 2) improves function (ability to walk or exercise 3) improves Quality of Life 4) is safe (no comorbidities. These all meet the requirements for reconstructive, medically necessary surgery. There are dozens of peer-reviewed studies indicating that liposuction for lipedema is safe and effective–and the only treatment once all conservative measures have failed.

    1. Hi Jeffrey! This is great information, thank you so much for sharing! I will update the content accordingly.


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