Does Medicare Cover Cosmetic or Reconstructive Surgery?
Americans ages 55 and up accounted for nearly 4.2 million cosmetic procedures in 2020 — and that’s a drop from previous years, due to the pandemic.
Plastic surgery is a huge industry, with $16.7 billion spent on cosmetic procedures in our country in a single year, according to the American Society of Plastic Surgeons’ most recent report.
If you’re a Medicare beneficiary, you may be wondering whether you’d be covered for cosmetic or reconstructive plastic surgeries. The answer to that question is going to depend on just how medically necessary the procedure might be.
What Types of Cosmetic Surgery Does Medicare Cover?
Cosmetic surgery reshapes body parts to enhance their visual appearance and may not be covered by Medicare. Medicare usually doesn’t cover cosmetic surgery unless it restores and improves the function of deformities or abnormal body parts. You will pay 100% for non-covered services.
The following surgeries require prior authorization and may be covered by Medicare:
Blepharoplasty is eyelid surgery. Medicare may cover reconstructive surgery when it functionally improves your vision. For example, the removal of droopy, fatty eyelids.
Botox is a neurotoxin injection to treat muscle disorders. Medicare may cover botox for the treatment of chronic migraines in adult patients. However, botox to treat skin wrinkles is not covered by Medicare.
Panniculectomy is surgery to remove excess skin and tissue from your lower abdomen. Medicare does not cover panniculectomy for cosmetic purposes.
Rhinoplasty is nasal surgery. Medicare may cover reconstructive surgery to improve nasal respiratory function. For example, nasal airway obstruction, including sleep apnea.
Vein ablation is the treatment of varicose veins of the lower extremity. Spider veins (dilated capillary veins) are most often treated for cosmetic purposes. Thus, vein ablation is most often not covered by Medicare.
Does Medicare Cover Reconstructive Surgery?
You may need reconstructive surgery due to one of the conditions mentioned above or some other injury or disease, and Medicare may cover it.
Outpatient cosmetic services covered by Medicare Part B require prior authorization. If Medicare approves your provider’s prior authorization request, you only pay your deductible and coinsurance.
If you had a mastectomy because of breast cancer, Medicare can cover some external breast prostheses. If you have surgery as an inpatient, Medicare Part A can cover surgically implanted breast prosthesis after a mastectomy. Otherwise, Part B can cover the surgery in an outpatient setting.
You may pay 20% of the Medicare-approved amount for Part B medical services and the external breast prostheses, and you may have to pay the Part B deductible.
A Medicare Supplement (or Medigap) plan can help cover your out-of-pocket costs. To shop Medigap plans with Senior Healthcare Direct, call 1-833-463-3262, TTY 711, to speak with a licensed agent, or get your quote.
LEGAL DISCLAIMER: The above is meant to be strictly educational and not intended to provide medical advice or solicit the sales of an insurance product or service of any kind.