Does Medicare Cover Cosmetic Surgery? 

Today, plastic surgery is quite common in the United States. In fact, over 16 million procedures are done annually. While most of these procedures are cosmetic surgeries like liposuction, tummy tucks, or breast enhancements, many are reconstructive procedures that can help patients regain bodily function or improve their quality of life. 

Reconstructive plastic surgery procedures are typically performed for medically necessary purposes like skin grafting or muscle repair after burns, breast implants after a mastectomy to treat cancer, or blepharoplasty that treats sagging eyelids that obstruct vision.  

Your Medicare insurance plan might cover its share of the cost of your plastic surgery, but it depends on why you need the procedure, and whether Medicare agrees that it is medically necessary. 

How does Medicare cover cosmetic surgery? 

Medicare doesn’t cover plastic (or cosmetic) surgical procedures that are solely for the enhancement of a patient’s appearance. However, Medicare does cover plastic surgery if your physician certifies that it’s a medically necessary procedure to repair damage after an accidental injury or trauma, to correct a body part malformation, or for breast reconstruction after a mastectomy that you have had to treat breast cancer.

Medicare may also cover the following types of plastic surgeries that are often considered to be cosmetic if you get authorization beforehand:

• Blepharoplasty (eyelid surgery) to treat droopy, fatty, or excess tissue causing vision issues
• Botox injections to treat muscle disorders
• Panniculectomy (surgical removal of excess skin and tissue from the lower abdomen often caused by extreme weight loss) 
• Rhinoplasty 
• Vein ablation 

If your physician suggests that you undergo one of the above-mentioned procedures to treat a medical condition, she or he must submit a written request for prior authorization to Medicare along with all documentation. If Medicare approves the request, you are responsible for paying your Part B deductible and coinsurance amount of 20 percent for the final cost of the procedure. 

If you’re enrolled in Original Medicare Parts A (hospital insurance) and B (medical insurance), your coverage depends on where you have your surgery. Medicare Part A covers procedures, such as surgically implanted breast prostheses, that you have after being admitted as a hospital inpatient in a facility that accepts Medicare assignment. 

If you have plastic surgery as an inpatient, Original Medicare Part A covers your surgical procedure and the following hospital services:

• A semi-private room 
• Meals
• General nursing care
• Medications and supplies relating to your inpatient treatment
• Some rehabilitation services
  

Through Medicare Part A, you are responsible for paying the deductible for each benefit period. You may also be charged coinsurance if your inpatient stay exceeds 60 days. 

How does Part B cover cosmetic surgeries covered by Medicare?

Medicare Part B covers outpatient procedures that are done by health care providers, physicians, or surgeons who accept Medicare assignment. The procedures must also take place in Medicare-affiliated medical facilities. 

Medicare Part B also covers external breast prostheses such as post-surgical bras for those who qualify for this benefit.  

Through your Medicare Part B, 80 percent of the final approved amount for covered outpatient surgical procedures and medical supplies is paid by Medicare, and you pay the remaining 20 percent after you’ve paid your annual deductible.  

How do MA plans cover cosmetic surgery?

If you’re enrolled in a Medicare Advantage (MA) plan, your provider must cover your plastic surgery if you are eligible according to Medicare requirements and the benefits covered by Original Medicare Parts A and B. MA plans are required to include all Part A and Part B benefits, but most plans include additional coverage.

Depending on the type of Part C plan you have, you may need to use health care providers, physicians, surgeons, hospitals, medical facilities, and other providers who are listed on your plan’s preferred network of providers to be eligible for coverage. If you go outside of these providers or facilities, you may have to pay out-of-pocket for all services and care.

Your coinsurance and deductible charges may also vary according to your MA plan, so check with your provider for coverage details if you aren’t sure.