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 crucial; if you think you qualify, talk to them to see if you’re eligible. Although, you should understand that the chances are slim.

You need a doctor to write a statement about why liposuction is essential for treatment. Most patients have a better chance at gastric bypass approval.

The terms for weight loss surgery are extensive. If you want liposuction surgery for cosmetic motives, they won’t pay.

An abdominoplasty, or tummy tuck, that meets certain standards will have coverage. Although, if the doctor thinks it cosmetic, you pay 100% of the costs.

Talk to your specialist, some doctors let you finance.

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 Coverage for Plastic Surgery is available for special cases

Medicare will only cover rhinoplasty surgery if it’s 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 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.

Medicare Advantage Coverage for 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 good as Medicare. So, if you receive a denial, file an appeal through the advantage plan.

Although, without medical proof, nobody will cover.

Medicare Supplement Coverage for Plastic Surgery

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.

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Lindsay Engle: Lindsay Engle is the Medicare expert for MedicareFAQ. She has been working in the Medicare industry since 2017. She is featured in many publications as well as writes regularly for other expert columns. She has a passion for sharing her expertise on Medicare to beneficiaries so they can be better prepared for healthcare costs after retirement. You can find her on YouTube where she has a featured channel for Medicare beneficiaries to become educated on all their options.
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