The plastic surgery industry continues to grow in popularity which means more Americans than ever before are seeking out cosmetic procedures to enhance and rejuvenate their appearance. Some of the potential patients for plastic surgery include those who are on Medicare which means they might be unsure about the procedures covered by their insurance. Let’s look at the rules that are in place for Medicare in order to see what is covered and which costs patients will need to pay for on their own.
In general, Medicare will cover plastic surgery that is considered to be medically necessary (as opposed to an elective procedure). Medically necessary plastic surgery includes procedures that fall under the heading of “reconstructive plastic surgery”. This is a plastic surgery category that include medical procedures performed to repair damage to areas of the body that are the result of injury or trauma, cancer or some sort of malformation such as a cleft lip or cleft palate. On the other hand, cosmetic plastic surgery is a procedure that is being performed in order to augment or enhance the appearance of a body part or rejuvenate the look of the facial features of the body.
Let’s take a deeper look and expand on the medical situations or issues where Medicare will normally cover the cost of plastic surgery:
There are also times when certain procedures can be considered to be both reconstructive and cosmetic in nature. Common examples include rhinoplasty which can give the nose a more aesthetic appeal and improved functionality or blepharoplasty (eyelid surgery) to restore vision that is blocked or impaired by excess skin and fat in the eyelids.
Some of the cosmetic surgery procedures that are not determined to be “medically necessary”, and will not be covered by Medicare, include a breast lift, liposuction or a facelift. If the procedure is considered to be for purely aesthetic reasons, there is a good chance that it will not be covered by Medicare.
The amount of the costs of a surgical procedure that patients will need to pay for on their own depends on the type of Medicare plan they have for their coverage.
Patients that want more information about whether or not their plastic surgery choice meets the criteria for being “medically necessary” should consult with the surgeon they want to perform the procedure. The surgeon can answer any questions about the procedure and its results along with questions about the portion of the surgery cost that will be covered by Medicare.
Even though the doctor will likely have the necessary information about which costs (if any) are covered by Medicare, there might be a need to check with another source of information. The healthcare provider can also provide the necessary information regarding any questions about coverage and costs. Finally, the patient can also contact Medicare directly to ask any questions they have about coverage of their “medically necessary” (or not) plastic surgery procedure.