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.
Typically, for eyelid surgery to be considered medically necessary, it must be for reconstructive purposes, such as:1
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.
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).
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 surgeryCompare Plans
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 Superseded Local Coverage Determination (LCD): Blepharoplasty.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&.
Copyright © 2019 TZ Insurance Solutions LLC. All rights reserved.
MedicareAdvantage.com is a website owned and operated by TZ Insurance Solutions LLC. TZ Insurance Solutions LLC and TruBridge, Inc. represent Medicare Advantage Organizations and Prescription Drug Plans having Medicare contracts; enrollment in any plan depends upon contract renewal.
Plan availability varies by region and state. For a complete list of available plans, please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.
Medicare has neither reviewed nor endorsed this information.