Does Medicare Cover Plastic Surgery?

History of Medicare

When the Medicare program became law in 1965, it was intended to offer health coverage and some level of financial security for seniors who were locked out of employment-related insurance protection. Since then, the program has undergone some enhancements, including Part C enacted in 1997 and Part D, which rolled out in 2003. In recent years, Part C, also known as Medicare Advantage, began offering extra benefits, such as fitness programs, over-the-counter allowances, meal delivery services, transportation to the doctor’s office, telehealth, wheelchair ramps and bathroom grab bars. However, these offerings have not extended to elective surgery.

Medicare Benefits Solutions

Aug 3, 2020

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Types of plastic surgery

Medicare benefits are limited to some types of plastic surgery deemed to be medically necessary, but this does not include cosmetic surgery. It may be helpful to understand the difference between the two. The purpose of cosmetic plastic surgery is to improve innate features for aesthetic purposes only. Examples are face lifts, liposuction, and body contouring. Medicare would not cover these procedures.

Reconstructive plastic surgery is performed to repair body parts impacted by injury, malady or developmental failings. According to the American Society of Plastic Surgeons, “reconstructive surgery can improve abilities, function and quality of life when structures on the body have been affected by congenital and developmental defects, trauma or disease.” 

Plastic surgery covered by Medicare 

Medicare benefits are available for three specific types of reconstructive plastic surgery. One is to remediate an accidental injury, such as skin burns. Another is to restore some functionality to a deformed body part. The malformation may be something you were born with, caused by disease or brought on by aging. Also, if you had a mastectomy due to breast cancer and need breast reconstruction, Medicare would cover breast prostheses, known as artificial implants. 

Confirm surgery is covered

There can be an overlap in surgery intended to enhance beauty and surgery performed to address a medical need. Examples are rhinoplasty and eyelid surgery. In some cases, they are needed to fix a problem that may adversely affect breathing or vision, respectively. However, following the surgery, you may find that your appearance has improved as a byproduct of correcting the issue. 

It is a good idea to check with your plan to ensure the type of plastic surgery you need is covered. The cost of any services rendered that are not covered will be your responsibility. For surgical procedures that are eligible for Medicare benefits, be prepared to pay the obligatory deductibles, coinsurance and copayments.

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