Does Medicare Cover Eyelid Surgery?

Medicare Advantage plans cover medically necessary eyelid surgery. Medicare Advantage plans also feature an annual out-of-pocket spending limit. Learn more about your options.

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.

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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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Christian

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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