If you are a Medicare beneficiary, you may be asking, Does Medicare cover plastic surgery? However, the answer is complex.
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Depending on the circumstance and procedure, Original Medicare may or may not cover plastic surgery. Medicare will not cover elective plastic or cosmetic surgery. Yet, medically necessary plastic surgery may receive coverage.
Below, we review Medicare’s guidelines for plastic surgery benefits. We review what Medicare covers, what is not, and how to find a physician to cover your services. Most importantly, we answer your original question, does Medicare cover plastic surgery?
Does Medicare Provide Coverage for Plastic Surgery?
Original Medicare typically does not cover elective cosmetic surgeries. However, Medicare may cover a medically necessary plastic surgery procedure.
Plastic surgery and cosmetic surgery are not the same. Plastic surgery repairs body parts that may suffer damage due to disease, trauma, or birth defects. Meanwhile, cosmetic surgery enhances certain features of your face or body.
Because the two types of surgeries are not the same, different doctors often perform them. However, many certified plastic surgeons also perform cosmetic procedures.
Medicare will only cover medically necessary plastic surgery after other treatment options have been unsuccessful. There is no circumstance where Medicare will cover elective cosmetic surgery.
Does Medicare Cover Plastic Surgery for Skin Removal or Tummy Tuck After Weight Loss?
Original Medicare will only cover a tummy tuck (abdominoplasty) if medically necessary after extreme weight loss or bariatric surgery. To be medically necessary, the loose skin must be causing discomfort or rash or interfere with your ability to perform daily tasks. Additionally, the procedure can treat an abdominal wall defect.
To qualify for Medicare coverage, you must maintain your weight for at least six months, monitored by a physician. Further, you must try other ways to reduce the loose skin for at least three months. You must provide documented progress and have a physician recommend the procedure.
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Does Medicare Cover Plastic Surgery for Breast Reduction?
There are cases when Medicare will cover breast reduction surgery. These include when you suffer from neck and back pain from large breasts. You can curb this pain and improve posture and breathing habits by receiving a breast reduction.
To qualify for a breast reduction surgery, you must have ongoing symptoms for at least six months and try non-surgical treatments with no improvement. However, Medicare will only cover breast prostheses if you have breast cancer.
If you have breast cancer, a lumpectomy or mastectomy can occur immediately or years later, depending on your needs.
Does Medicare Cover Plastic Surgery After Mohs Surgery?
Mohs surgery can be crucial when treating certain skin cancers. A dermatologist often recommends this surgery to help remove cancerous skin cells.
This procedure involves removing skin tissue to remove the cancerous cells. However, Medicare will not cover plastic surgery after Mohs surgery in most cases.
Original Medicare will cover the Mohs surgery procedure. However, it will not cover the cost of reconstructive surgery for the removed skin.
What Plastic Surgery Procedures Does Medicare Cover?
Original Medicare will cover plastic surgery when it reconstructs an area of the body that has suffered damage due to an operation or injury. Medicare must provide approval for the procedure to receive coverage.
Typical covered conditions include:
- Accidental injury – If you are injured in an accident that produced visible trauma to a part of your body, you may be eligible for Medicare-covered plastic surgery. For example, if you fall and suffer damage to your mouth, Medicare may cover the required plastic surgery to restore your mouth’s prior appearance and functionality.
- Breast reconstruction after mastectomy – Suppose you are diagnosed with breast cancer and have a mastectomy. In that case, Medicare will typically cover the reconstruction surgery for your breasts as well as external breast prosthesis and post-surgical bras.
- Malformation – Medicare will cover plastic surgery to repair malformed body parts if deemed medically necessary. However, malformation is the trickiest plastic surgery procedure to be approved. If the surgery is not deemed medically necessary, Medicare will not cover it.
- Rhinoplasty – Rhinoplasty is a nose job. Medicare will cover the plastic surgery costs if you require a nose job to help alleviate strained breathing, fix a congenital defect or traumatic injury, or treat chronic nasal obstruction. However, the procedure must be medically necessary, and your physician must prove that a less invasive treatment option will not adequately treat the complication.
- Vein Ablation – Vein ablation can treat veins that cause skin ulcerations, decrease the frequency of superficial thrombophlebitis, and treat pain and swelling that will not go away with medication.
- Blepharoplasty – If you suffer from painful eye spasms, nerve palsy in your eye, obstructive upper eyelid, or complications from other medical conditions, Medicare may cover blepharoplasty. Additionally, if plastic surgery is necessary in preparation for a prosthetic eye, Medicare will also cover the cost of the surgery.
- Botox injections – This may come as a surprise as Botox injections are typically considered a cosmetic procedure. However, in many cases, Botox can treat severe migraines and muscle spasms in the neck. If you have tried other medications and nothing is working, Medicare may cover the cost of Botox injections as treatment.
The above list is not all-encompassing when it comes to Medicare-covered plastic surgery. However, it is some of the most popular covered surgeries. In every case, your physician must deem the surgery medically necessary, and the case will have to be reviewed individually by Medicare to decide if the treatment will receive coverage.
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What Plastic Surgery Procedures Does Medicare Not Cover?
If plastic surgery is not medically necessary, Original Medicare will not provide coverage. If a surgery’s sole purpose is to alter your appearance for cosmetic reasons, you must pay out-of-pocket.
Common cosmetic surgeries Original Medicare does not cover are:
- Facelift
- Breast Lift
- Body contouring
Medicare Plastic Surgery Prior Authorization Process
For Medicare to cover plastic surgery, it must pass a prior authorization process. This process requires authorization before the surgery. If the doctor’s office fails to receive prior approval, Medicare will not cover the costs of the procedure.
Your physician’s office must provide Medicare with medical records indicating that plastic surgery is medically necessary. Based on your medical records, a Medicare Administrative Contractor will determine whether Medicare will pay for the procedure.
Each Medicare Administrative Contractor can individually determine the necessity of the requested procedure. So, a procedure may receive coverage under one condition but not under another. This process can take up to two or more weeks.
Once an Administrative Contractor approves a procedure, Medicare will cover the costs. However, if the prior authorization is denied, your physician may provide more documentation until it is approved. Or, you may be responsible for the full cost of the procedure.
If your prior authorization request was denied or your physician did not get proper clearance from Medicare, you may need to sign an Advance Beneficiary Notice. This is a document stating that Medicare may not cover your costs, and you could need to cover the services in full.
How Much Does Plastic Surgery Cost With Medicare?
The cost of plastic surgery with Medicare varies depending on the type of surgery.
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If you receive a Medicare-covered plastic surgery that requires an inpatient hospital stay, Medicare Part A and Part B will cover your costs. However, if you are receiving an outpatient plastic surgery procedure, Medicare Part B will provide coverage. Additionally, any medications you require following the surgery will receive coverage by Medicare Part D.
Since most medically necessary plastic surgeries are inpatient, Medicare Part A will cover your first 60 days in the hospital at 100% after you meet the Medicare Part A deductible. Then, after you reach the Medicare Part B deductible, your plan will cover you at 80%. However, you can enroll in a Medicare Supplement plan to help offset these costs.
How to Find Plastic Surgeons Who Accept Medicare
If Original Medicare approves a plastic surgery, you will need to find a plastic surgeon in your area who accepts Medicare and will perform the procedure. However, you will not receive 100% coverage. You will still be responsible for the cost-sharing associated with Medicare Part A and Part B. To cover these costs, people often enroll in a Medicare Supplement plan.
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Sources:
MedicareFAQ is dedicated to providing you with authentic and trustworthy Medicare information. We have strict sourcing guidelines and work diligently to serve our readers with accurate and up-to-date content.
- Cosmetic and Reconstructive Surgery,CMS . Accessed June 2022.
https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=35090&ver=95&= - Cosmetic Surgery, Medicare. Accessed June 2022.
https://www.medicare.gov/coverage/cosmetic-surgery
I just recently had baractric sleeve surgery and medicare covered. Does medicare cover saggy skin removal after the weight loss?
Cindy, Medicare will not cover cosmetic surgery, even if it was a result from a Medicare covered service.
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??
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.
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 ?
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.
Will Medicare give any reimbursement for abdominoplasty to repair diastasis recti for treatment of chronic low back pain?
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.
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.
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.
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.
I have uneven breasts.. will medicare help pay for them to be fixed
Hi Jessica – if the surgery is elective/cosmetic and not medically necessary, Medicare will not pay.
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 done.in 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.
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.
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.
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.
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?
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.
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.
Hi Elizabeth! Yes, if your doctor feels its medically necessary to remove them from other areas of your body, Medicare will cover it.
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.
Hi Tanya! If your doctor says it’s medically necessary then Medicare will cover it.
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?
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.
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.
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.
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
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.
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.
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 plan?
Thank you so much for taking the time to reply. I have Medicare parts A and B, as well as part D prescription coverage.
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.
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
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.
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?
Hi Jodie! If your doctor says it’s medically necessary, then Medicare will cover it.
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!
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!
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
Hi Angela. Have you been on disability for at least 24 months & are eligible for Medicare?
Hi Lindsay Engle where can I find a plastic surgeon to take my medicare
Hi Towana! You can use the Medicare care compare tool.
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?
Hi Colleen! As long as your doctor says it’s medically necessary to remove the extra skin, Medicare will cover it.
I know that Medicare will authorize a tummy tuck if medically necessary, but does it also cover excess skin on the arms or back?
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.
Will Medicare cover medically needed removal of leaking breast implants ?
Hi Georgette! Yes, Medicare will cover the removal of breast implants that are leaking and/or ruptured.
Will Medicate + Supplement F cover a rhinoplasty as a result of excessive cancer lesions on the nose?
Hi Julianne! If your doctor says the rhinoplasty is medically necessary, then Medicare will cover the surgery.
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.
Hi Jeffrey! This is great information, thank you so much for sharing! I will update the content accordingly.