Does Medicare Cover Plastic Surgery?

• by Christian Worstell
• August 23, 2023
• Reviewed by John Krahnert

Original Medicare (Part A and Part B) typically does not typically cover plastic surgery. In some limited circumstances, Medicare may cover cosmetic surgery due to an accident, as part of another surgical treatment or to improve a malformed body part.

Medicare Advantage (Part C) plans may cover plastic surgery, if the surgery would otherwise be covered under Original Medicare.

When does Medicare pay for plastic surgery?

Medicare may cover a plastic surgeon if it is a reconstructive procedure performed on an area of the body that is malformed or damaged due to injury or an operation. The goal of the cosmetic surgery is to restore a normal appearance and/or function.

Plastic surgery is typically only covered by Medicare if it is for an approved condition, such as:

• Breast reconstruction following mastectomy
  Breast reconstruction and external breast prostheses (including post-surgical bras) are typically considered eligible for Medicare coverage following cancer treatment.
  
  
• Accidental injury
  Accidental injuries that have caused trauma or damage to a body part may be approved for plastic surgery covered by Medicare.
  
  For example, if you are in a car accident and suffer damage to your eye, Medicare may cover necessary plastic surgery to restore the appearance and function of the affected eye.
  
  
• Malformation
  Plastic surgery to fix malformed body parts may be covered by Medicare if they are deemed medically necessary by your doctor.

Medicare does not provide any coverage for selective plastic surgery. You will have to pay 100% of the costs out of pocket for selective cosmetic surgeries, such as:

• Breast enlargement
• Face lifts
• Rhinoplasty (plastic surgery to change the shape of your nose) that is purely cosmetic

Medicare may cover rhinoplasty if your doctor or provider gets prior authorization from Medicare for the procedure.

How much does plastic surgery cost with Medicare?

Even if Medicare covers your plastic surgery, there are some out-of-pocket costs you should expect to pay, depending on where you receive your surgery.

• For example, if you undergo surgery for breast prostheses after a mastectomy, your Medicare Part A hospital insurance would cover your hospital costs if the surgery takes place in an inpatient hospital setting.

The Medicare Part A deductible is $1,600 per benefit period in 2023.

The Part A deductible is not annual, and you could experience more than one benefit period in a given calendar year.

After you meet your Part A deductible in a benefit period, you could face Part A coinsurance costs for an inpatient hospital stay that lasts longer than 60 days (which is not common for most plastic surgeries).

• If your surgery takes place in an outpatient setting, Part B will help cover your plastic surgery costs.
  
  The Medicare Part B deductible is $226 per year in 2023.
  
  After your Part B deductible is met, you typically pay 20 percent of the Medicare-approved amount for most doctor’s services.

There is no annual limit on how much you could pay for the Part B coinsurance in a given year.

We recommend speaking with your doctor directly for specific cost and coverage information.

Medicare Advantage plans can cover some plastic surgery costs

Medicare Advantage plans are required to cover the same benefits that Original Medicare covers.

If your plastic surgery, such as breast prostheses implantation, is covered by Original Medicare, it will also be covered by a Medicare Advantage plan.

A licensed insurance agent can help you compare Medicare Advantage plans that are available where you live. Some plans may be able to help pay for your Medicare-covered plastic surgery costs.

About the author

Christian Worstell is a senior Medicare and health insurance writer with MedicareAdvantage.com. He is also a licensed health insurance agent. Christian is well-known in the insurance industry for the thousands of educational articles he’s written, helping Americans better understand their health insurance and Medicare coverage.

Christian’s work as a Medicare expert has appeared in several top-tier and trade news outlets including Forbes, MarketWatch, WebMD and Yahoo! Finance.

Christian has written hundreds of articles for MedicareAvantage.com that teach Medicare beneficiaries the best practices for navigating Medicare. His articles are read by thousands of older Americans each month. By better understanding their health care coverage, readers may hopefully learn how to limit their out-of-pocket Medicare spending and access quality medical care.

Christian’s passion for his role stems from his desire to make a difference in the senior community. He strongly believes that the more beneficiaries know about their Medicare coverage, the better their overall health and wellness is as a result.

A current resident of Raleigh, Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism.

If you’re a member of the media looking to connect with Christian, please don’t hesitate to email our public relations team at Mike@tzhealthmedia.com.

 

 

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