Medicare and Plastic Surgery - What Does it Cover

Posted January 20, 2021
Is plastic surgery covered by medicare

Medicare is a health insurance program that was created to help elderly individuals meet their health cost needs including both hospital and medical costs. In general, Medicare is available to most individuals that are 65 years of age or older. As people get older, they often want to make a change in their appearance by undergoing a plastic surgery procedure such as a facelift or liposuction to alter or enhance the look of certain areas of the body. Patients that are on Medicare are sometimes not sure if the program covers any, or all, plastic surgery costs. Let’s examine this subject and help those on Medicare learn what costs the program covers when it comes to plastic surgery.

Medicare and Plastic Surgery Costs

One of the first things Medicare patients should know is that the program does not cover elective cosmetic surgery procedures which are procedures that are not deemed to be medically necessary. Medicare will cover some plastic surgery procedures that are considered to be medically necessary if they are determined to be the result of some type of trauma or injury to the body, a disease or a developmental defect that is impacting a certain part of the body:

  • An injury or trauma to the body, such as burns, can often result in a good amount of damage to the skin, bones or muscles of the body. 
  • A disease such as breast cancer can result in a person needing breast reconstruction surgery. Patients can require either a full or partial mastectomy to treat breast cancer which will then result in the need for breast reconstruction. The process of breast reconstruction can be performed using breast implants or through the use of the body tissue of the patient during a tissue flap reconstruction surgery.
  • Birth defects that have never been addressed in the past, along with developmental abnormalities, can have an impact on the development and formation of certain body parts. There are some cases where plastic surgery can be used to help alter and improve the functionality of these impacted body parts.

Combining Reconstructive Plastic Surgery and Cosmetic Procedures

There are times when plastic surgery procedures that are deemed to be medically necessary can also improve the aesthetic look of a body part. Some examples include blepharoplasty, AKA eyelid surgery, to restore vision that is blocked by excess skin and fat in the eyelids and rhinoplasty to improve the breathing ability of a person while also improving the appearance of the nose.

While these examples could fall under the category of being “medically necessary” procedures, patients will need to speak with their doctor to find out if the desired plastic surgery procedure is covered by Medicare.  

Cosmetic Surgery Procedures Not Covered by Medicare

Some examples of cosmetic surgery procedures that are not considered to be medically necessary include:

Patients that decide to have any of these procedures need to know that they will not be covered by Medicare. They will have to pay for the entire procedure out of pocket. These out of pocket costs can include the cost of the surgery along with any fees charged by the doctor or the medical facility.

Costs Medicare will Cover for Patients

Medicare patients that have been admitted to a hospital for plastic surgery due to any type of trauma or injury will have their hospital stay and any inpatient procedures covered by Medicare Part A.

Medicare patients that have to undergo medically necessary plastic surgery procedures in an outpatient setting will have these procedures covered by Medicare Part B.

Any medically necessary plastic surgery procedures that are covered under original Medicare will also be covered under Medicare Advantage (Part C). The main difference between these two plans is the amount of the copayment owed by a patient.

Consult with Your Doctor

Any patients that are covered by Medicare should schedule a consultation appointment with their doctor to get in-depth details about what costs their insurance plan will cover. Patients that do require reconstructive plastic surgery procedures should be covered under their Medicare plan. The need to repair any damage caused by trauma or injury to a body part, or to improve the functionality of a body part such as the nose, is generally considered to be medically necessary for patients of all ages including those that are covered by Medicare.

The consultation appointment is the time for patients to ask any questions they have about their desired procedure including the recovery process, any risks or complications and the type of results that can be expected after the surgery. Patients can also ask to see “before and after” photos of actual patients in order to get a better idea of the type of results provided by the surgeon.

Once Medicare patient have all of the answers they want to know, the plastic surgery procedure can be scheduled.



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