Does Medicare Cover Eyelid Surgery?

Eyelid surgery (blepharoplasty) may be covered by Medicare if it is considered medically necessary and reconstructive (rather than cosmetic).

Medicare Advantage plans (Medicare Part C) cover eyelid surgery if it is considered medically necessary by your doctor, and they also offer an annual out-of-pocket spending limit, which Medicare Part A and Part B do not offer.

Woman gets an eye exam from her doctor

When does Medicare cover blepharoplasty?

Typically, for eyelid surgery to be considered medically necessary, it must be for reconstructive purposes, such as:1

  • You have drooping eyelids (ptosis) that causes visual impairment
  • A trauma or another eye surgery caused defects to your eyelid
  • You have painful symptoms due to abnormal contraction of the eyelid muscles (blepharospasm)
  • You experience eyelid complications due to thyroid disease and nerve palsy

Be sure to check with your doctor before receiving services to see if your eyelid surgery will be covered by Medicare.

If your vision is not impaired, eyelid surgery is considered cosmetic and will not be covered by Medicare.

Mandy Medicare Advantage plans also cover vision care

Medicare Advantage (Medicare Part C) plans are sold by private insurers and provide the same hospital and medical benefits as Medicare Part A and Part B (Original Medicare).

In addition to these standard benefits, some Medicare Advantage plans also cover vision, dental and prescription drug coverage, which are not typically covered by Original Medicare.

If your vision is impaired due to blepharoptosis or another condition and requires the care of an ophthalmologist, a Medicare Advantage plan that covers vision may help cover some of the costs associated with your routine eye care.

Keep in mind, your plan will likely not cover eyelid surgery if the need for it is strictly cosmetic.

Specific benefits and costs will depend on the Medicare Advantage plan in which you enroll, but there may be $0 premium plans in your area.

Find a Medicare Advantage plan that covers eyelid surgery

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Or call TTY Users: 711 24/7 to speak with a licensed insurance agent.

 

1 CMS. Superseded Local Coverage Determination (LCD): Blepharoplasty. (Revised Oct. 1, 2018). Retrieved from www.cms.gov/medicare-coverage-database/details/lcd-details.aspx?LCDId=33944&ContrId=239&ver=16&ContrVer=1&CntrctrSelected=239*1&Cntrctr=239&DocType=2&bc=AAACAAQAAAAA&.