Will Medicare Cover Me for Cosmetic Surgery?

Will Medicare Cover Me for Cosmetic Surgery? : Everyone likes to look good, and plastic surgery is designed to repair a person’s function and possibly enhance their appearance. Yet, there is a cost to functioning well and looking great, and the associated medical expenses can be expensive.

If you have Medicare, you may be wondering if Medicare will pay for plastic surgery that you want or need.

Medicare has many rules for what it will and won’t cover, and it’s prudent to learn upfront whether Medicare will pay for the procedures you are considering. The good news is Medicare will pay for some procedures under certain circumstances.

We’ll give you an overview of the types of situations where Medicare will pay for plastic surgeries, what is excluded under the plan, and what you can expect to pay out of your pocket.

Does Medicare Cover Plastic Surgery Procedures?

To understand whether Medicare will cover a plastic surgery procedure, let’s review the various parts of Medicare that might be applicable.

Part A pays for hospitalization expenses.
Part B pays for physician services.
Part D pays for prescription drug care.
Medicare Advantage is a plan that bundles Part A, B, D, and additional services such as hearing aids, vision care, and dental care.

If your plastic surgery falls within Medicare’s rules and the surgery must take place in a hospital setting, the plan will pay for a semi-private room, nursing care, and meals under Part A. Part B will cover physician fees (inpatient and outpatient) and outpatient surgeries.

The medical bills for prescription drugs will be paid out under Part D whether the surgery was inpatient or outpatient.

The same rules for plastic surgery apply for Medicare Advantage plans as for Original Medicare plans.

Is your Surgery Reconstructive or Cosmetic?

Generally speaking, Medicare will not cover procedures that are being performed solely for the sake of appearance.

By contrast, Medicare will pay for surgeries that are reconstructive in nature. In other words, if someone is injured in an accident or experiences some kind of physical trauma, the plan will pay to restore the body to its prior functioning. Sometimes plastic surgery may be necessary for a person to regain full functioning.

Is There a Difference Between Plastic Surgeons and Cosmetic Surgeons?

The type of doctor you are consulting with may provide some clues as to whether your surgery might be covered under Medicare.

For example, cosmetic surgeons are certified by the American Board of Medical Specialties after completing a four-year residency program. If they wish, they can become certified by the American Board of Cosmetic Surgery.

On the other hand, plastic surgeons have at least six years of surgical training followed by three years in residency. They are certified to perform plastic surgery by the American Board of Plastic Surgery and may only do surgeries in accredited or licensed medical facilities. Plastic surgeons must take continuing education classes annually.

Cosmetic surgeries will not likely be covered by Medicare, while plastic surgeries related to injuries or trauma are more likely to be covered.

Types of Plastic Surgeries That May Be Covered by Medicare

While Medicare doesn’t cover cosmetic procedures, it will cover plastic surgery that is reconstructive in nature. Reconstructive procedures are those that restore or correct the function and appearance of the body.

Several things can interfere with a person’s ability to function. Diseases and injuries can impede a person’s ability to walk, talk, move their limbs, swallow, breathe, or perform other normal functions. Congenital abnormalities or traits that have existed for a long time may need treatment. These types of medical conditions can hinder a person’s functioning and also negatively impact their appearance. People with such conditions may suffer from low self-confidence and poor self-perception. When these types of situations call for plastic surgery, Medicare usually covers them.

Here are some examples of plastic surgeries Medicare will pay for:

Breast reconstruction after a mastectomy
Surgery to repair a cleft lip
Nose surgery (rhinoplasty) to improve breathing
Facial reconstruction after an accident or burn
Correcting a malformation of the body

It is common for cosmetic surgeries and reconstructive surgeries to overlap. For example, if a person needs surgery to repair a broken nose after being involved in a car accident, Medicare will pay to repair the broken nose and the plastic surgery to facilitate healing and improve the nose’s appearance.

As another example, Medicare will pay the cost of plastic surgery and skin grafts for a person who has burns to their face and hands or anywhere else on their body. In this case, plastic surgery will improve how the face and hands function and enhance the physical appearance of the skin.

Exclusions Under Medicare for Plastic Surgery

Every type of insurance policy carries exclusions, and Medicare is no exception. The following procedures are not covered under Medicare when the sole reason for scheduling them is cosmetic:

Botox
Laser treatments
Chemical peels
Microdermabrasion
Tummy tuck
Facelift
Liposuction
Body contouring
Breast lift
Breast augmentation not connected with breast reconstruction

If you are interested in having any of these medical services performed, you can expect to pay for the entire cost out of your pocket.

Expenses You May Have to Pay Out-of-Pocket for Plastic Surgery

When you are having plastic surgery that qualifies under Medicare, your plan may not cover the entire surgery. Just as with any other health plan, you will have to pay your deductible first before Medicare will pay the rest of the bill. You will also have to pay any applicable copays or coinsurance fees.

Nonetheless, if you have a Medigap plan, it will cover your deductibles, copays, and coinsurance fees.

Final Considerations with Plastic Surgery Under Medicare

Be aware that Medicare may require you to obtain authorization before having any type of surgery, especially as it relates to plastic surgery.

Also, because of the high cost of medical care, it’s important to plan ahead for your out-of-pocket costs. You won’t want to have a painful procedure with a lengthy recovery, and then find out you also have large medical bills to pay.

Finally, as a rule of thumb, Medicare will not pay for plastic surgery procedures that exclusively enhance your appearance. However, Medicare will pay for procedures that are necessary if you are injured in an accident or have a malformed body part as long as it will help you heal and improve your overall functioning.

Only you can determine whether it is worth it to pay the required out-of-pocket costs to have plastic surgery that Medicare doesn’t cover.