Medicare does supply insurance coverage for reconstructive plastic surgery that is medically necessary. This would include the repair of damaged areas to the body resulting from trauma, injuries, developmental birth defects or serious diseases such as cancer. It will not cover elective cosmetic plastic surgery that is deemed medically unnecessary.
Are Any Cosmetic Plastic Surgical Procedures Covered Under Medicare?
Some plastic surgical procedures such as nose jobs or eyelid lifts, which are normally considered to only be elective procedures, are covered under Medicare if they are found to be medically necessary. These include a rhinoplasty procedure when it is medically necessary to improve a patient’s impaired ability to breathe through the nose due to a malformed nasal passageway or a lid lift procedure to remove any excess skin in the eyelids that is blocking normal vision.
What Inpatient Medically Necessary Plastic Surgical Procedures are Covered by Medicare?
Most medically necessary plastic surgical procedures require inpatient hospitalization and at least an overnight stay in the hospital. The following are some examples of medically necessary plastic surgical procedures that Medicare typically pays for:
- Cleft palate or cleft lip plastic surgery
- Augmentation of the facial area
- Tissue Flap or Prosthetic Breast Reconstruction Surgery
- Lower or Upper limb Surgery
Does Medicare Always Cover Plastic Surgery After a Mastectomy for Breast Cancer?
Any Medicare patient who has undergone either a partial or full mastectomy (surgical removal of the breast) is eligible under Medicare rules to be deemed eligible for breast reconstructive surgery. Breast reconstructive surgery can include either the implantation of artificial breast implants, which is also known as prosthetic reconstruction, or with the use of the patient’s own body tissue, which is called tissue flap reconstruction. This involves transposing healthy tissue from an area of healthy tissue, such as the back, to the patient’s chest where the cancerous breast tissue has been surgically removed.
How Much Does Medicare Part A Pay for Medically Necessary Plastic Surgery?
If you have Original Medicare and are admitted to the hospital and require medically necessary plastic surgery for either trauma or other types of severe injuries, Medicare Part A (covers inpatient hospital stays) will pay for your stay in the hospital, but you will be responsible for your deductible for the benefit period involved.
The amount of the deductible owed for each benefit period in 2022 is $1,556. The good news is that if you are admitted to the hospital and stay as an inpatient for a period of less than sixty days, you will not be responsible for paying any additional coinsurance payments. Visit Medicare Part A in Detail for more information.
However, if you wind up staying as an inpatient in the hospital for a period of more than sixty days (61 days or more), you will be responsible for paying any amounts of co-insurance due. This amount will be based on the length of time of your hospital admission.
How Much Does Medicare Part B Pay for Medically Necessary Plastic Surgery?
The out-of-pocket deductible for Medicare Part B is $233 for 2022. Once you have met this deductible, the cost-sharing (coinsurance) component will kick-in. Patients are typically responsible for paying 20% of the related costs for the surgery and Medicare will cover the other 80% of related coinsurance expenses. Visit Medicare Part B In Detail for more information.
How Much Does Medicare Part C Pay for Medically Necessary Plastic Surgery?
Medicare Advantage Part C will incorporate the coverage of Medicare Part A and B and typically provides additional benefits like vision and dental plans through private insurance companies. The Advantage plans may have higher copayments for primary care and specialist doctor’s outpatient visits and could be significantly higher if you use out of network medical providers.
- Cosmetic Surgery, Medicare.
- Cosmetic and Reconstructive Surgery, CMS.