How Medicare Coverage and Cosmetic Surgery Can Go Together

The confusion about Medicare policy for cosmetic surgery is unlikely to change in the coming years. Although Insurance companies are required to cover medically necessary plastic surgery under Medicare, elective surgeries are not covered by the federal program. This inconsistency in coverage has led to tremendous confusion about medicare coverage and cosmetic surgery.

Medicare has a list of what it will cover and what it will not cover when it comes to plastic surgery. There are certain procedures that Medicare will not cover, while other procedures require you to pay out-of-pocket. This article will take a closer look at its rules for cosmetic surgery.

Reasons For Confusion Between Plastic & Cosmetic Surgery

Here are some key differences between a plastic and a cosmetic surgeon:

1. When treating certain parts of the body, plastic surgeons can use reconstructive surgery to repair the damage done by trauma, disease, or developmental defects. Cosmetic plastic surgery is a type of plastic surgery that is used to change the appearance of natural body parts without affecting their function.

2. A plastic surgeon will have different education and training from a cosmetic surgeon, but both require four years of medical training and residency. Additionally, plastic surgeons can decide to get additional training at any point in their career to become cosmetic surgeons.

3. Both surgeons also have different certifications. The American Board of Plastic Surgery certified plastic surgeons in the United States. This board is highly regarded by healthcare providers and their patients. It helps people find qualified surgeons for all of their plastic surgery needs. A cosmetic surgeon is certified by the American Board of Medical Specialists.

4. Both surgery procedures are relatively safe and effective. However, patients require a thorough understanding of the risks and benefits involved in each individual case. 

Medicare’s Position on Plastic and Cosmetic Surgery

Medicare only covers a few plastic surgery procedures. However, patients can get help with their cosmetic needs if this type of surgery is considered medically necessary. This can occur in the case of breast cancer or a malformation after an accident.

There are some medically necessary plastic surgery procedures that may also classify as cosmetic surgery procedures that can help individuals not only solve a physical problem but also look more attractive after surgery. In these instances, it is covered by Medicare.

Two examples are rhinoplasty and excess skin around the eyes.

1. Rhinoplasty

Rhinoplasty is a surgical procedure that reshapes the nose by removing excess skin, bone, and cartilage to create a more aesthetically pleasing shape. It can also correct a malformed nasal passage so it can be easier for someone to resolve their breathing problems. A straighter and more symmetrical nose is also more efficient at breathing properly.

2. Excess Eyelid Skin

The skin around the eyes is very sensitive and delicate, making it difficult to perform minor surgeries on the area. When excess eyelid skin is removed, vision problems can also be resolved. They will also look more attractive.

What Medicare Will Cover

Medicare will cover some outpatient and inpatient procedures if they provide the patient with medical benefits.

1. Outpatient Procedures.

Medicare covers some outpatient plastic surgery procedures such as rhinoplasty. Rhinoplasty is done in an outpatient clinic, and you can return home the same day.

2. Inpatient Procedures.

Inpatient plastic surgery procedures that Medicare may cover include both surgical and non-surgical procedures. Non-surgical procedures include injectables, fillers, lasers, botox, and peels. The average cost for all these non-surgical treatments is roughly $4,500 to $5,500.

Some examples of inpatient procedures covered by Medicare include upper or lower limb surgery, facial augmentation, cleft lip surgery, palate surgery. prosthetic surgery, and tissue flap breast reconstruction.

Who Covers Cosmetic Surgery

The use of cosmetic surgery to improve appearances is a growing trend in the United States. It’s estimated that 18 million people get cosmetic surgery every year.

Medicare will not cover procedures that are not considered medically necessary. Some examples are tummy tuck, facelift, breast lift, liposuction, and body contouring.

Incidentally, insurance companies, too, will not cover these types of procedures either. Unlike other medical procedures, cosmetic procedures are not covered by insurance companies. This means that many people will have to pay for these services out of pocket. It is crucial to research the costs and demand for a given procedure before surgery.

However, there are some types of cosmetic surgery that need to be reviewed to see if they are considered medically necessary. Breast augmentation, for example, is covered by Medicare only after a mastectomy.

A Quick Overview of Medicare Coverage

Although Medicare Part A is designed to cover medical costs associated with any hospital stay, it does not cover outpatient or day surgery procedures. A patient must pay the full cost of these procedures and then submit a claim to their insurance provider after they’ve left the hospital.

If you’re uninsured, Medicare Part B will not cover any out-of-network expenses. There are different types of surgery covered under Part B, including breast reconstruction, liposuction, nose reshaping, and more.

Medicare Part C will cover procedures that were part of the original Medicare.

Medicare Advantage is a Medicare program that will provide prescription drug coverage at a lower cost. To help seniors afford this coverage, the government decided to cover certain plastic surgery procedures that are not covered by their original plan.

Final Thoughts

Plastic surgery is one of the most popular cosmetic operations today. It has been in existence for centuries and was initially known as “plastic” because it served to reconstruct and reshape the body. Plastic surgery is used to correct specific defects, deformities, or disabilities. It is different from cosmetic surgery is a type of plastic surgery which can be done simply for esthetic purposes.

Unfortunately, over time this clear distinction has blurred. Many people use them interchangeably. For this reason, it has made it difficult for people to understand Medicare’s position on plastic and cosmetic surgery. While it’s possible to point to some general rules on what Medicare will or will not cover, it’s always best to consult with a Medicare advisor for a final opinion.