Does Medicare Cover Plastic Surgery?

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 surgery, an accident 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.

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When does Medicare pay for plastic surgery?

Medicare may cover plastic surgery 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 comsetic surgeries, such as:

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

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 $1,364 per benefit period in 2019.

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 $185 per year in 2019.

    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.

 

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