Does Medicare cover Plastic Surgery?
In a perfect world, we would all be born with the ideal physique to keep us looking young for life. But that is certainly not the case. We all have imperfections, and we all go through the aging process.
But we often turn to surgery to correct things that bother us, such as our noses or sagging eyes. And sometimes, cosmetic surgery is medically necessary, such as in the case of disfigurement or cancer.
Most importantly, private insurance will not cover plastic surgery unless it is medically necessary. But about Medicare? Does Medicare cover plastic surgery?
Unless it is medically necessary, Medicare generally will not cover cosmetic surgery. However, if it is like breast reconstruction as part of cancer treatment, Medicare will usually cover it.
This article will discuss cosmetic surgery and what is considered elective and non-elective. I will also talk about other ways that you may be able to pay for plastic surgery.
What is Medicare?
Medicare is the federal government health insurance program in the United States. It generally covers folks who are 65 years and older. It also covers younger people with disabilities or those with renal failure.
You are covered under Medicare no matter what your income is. In addition, patients may pay part of the care costs through hospital deductibles and other fees.
Because Medicare is a federal program, it is the same throughout the United States, and it differs from Medicaid in that Medicaid is an assistance program.
What is Plastic Surgery?
By definition, plastic or cosmetic surgery involves reconstruction, restoration, or alteration of the body. Therefore, it is generally divided into reconstructive surgery and cosmetic surgery.
Reconstructive surgery is usually medically necessary, while cosmetic surgery is done strictly for cosmetic reasons.
Reconstructive surgery is done when there are functional impairments caused by injuries, burns, fractures and breaks, abnormalities such as cleft lip, or those resulting from diseases such as cancer.
Examples of reconstructive surgery are:
- Scar revision
- Tumor removal
- Maxillofacial surgery
- Hand surgery
- Breast reduction
- Breast reconstruction after a mastectomy
- Cleft palate surgery
Cosmetic surgery is a surgery that is voluntary and only for the benefit of improving one’s self-image, such as a facelift, breast augmentation, or rhinoplasty.
Examples of Cosmetic Surgery are:
- Abdominoplasty (tummy tuck)
- Buttock augmentation
- Lip injections
- Brow lift
- Laser skin rejuvenation
Does Medicare Pay for Plastic Surgery?
Medicare will usually cover plastic surgery if needed due to an accident, illness, or malformation. Medicare usually does not pay for plastic surgery on a purely cosmetic basis. However, there are often when the two surgeries are interchangeable. In that case, Medicare may cover the cost.
Here are some examples of plastic surgery that Medicare will likely pay for.
Reconstruction of the Breasts After a Mastectomy
As part of treatment for breast cancer, a mastectomy is often needed. A mastectomy is the removal of one or both breasts. Follow-up surgery is for the reconstruction of the breast, which can include reshaping or rebuilding the breast.
Reconstruction After an Accidental Injury
Traumatic injuries can often leave people with crushed bones or burns to the skin that can affect function and appearance. Medicare usually covers reconstructive surgery to correct facial injuries or to treat burns.
Cosmetic Surgery That is Medically Necessary
Most people opt for cosmetic surgery to improve their appearance, such as rhinoplasty to straighten a bump in the nose or make it smaller. However, when this procedure is purely for cosmetic reasons, Medicare will not cover the procedure.
But if the patient needs rhinoplasty due to a medical condition, such as difficulty breathing or a deviated septum, Medicare will likely pay for the surgery.
So although the result of the surgery may be cosmetically beneficial, the reason for the surgery remained medically necessary.
Correction of a Malformation
Certain congenital conditions may result in structural abnormalities, affecting the patient’s appearance and function.
An example would be a cleft lip presented from birth and easily treatable with plastic surgery.
Other Ways to Pay for Cosmetic Surgery
They exist if you are considering cosmetic surgery and looking for other ways to pay for your procedure. But be wise because cosmetic surgery can cost you thousands of dollars.
You can always put your surgery on a credit card but if you do so, opt for one with low interest. Often applying for a new card will give you an introductory period with 0% interest.
A credit card is also an excellent way to build your credit if you are younger. But be sure to know your credit limit before tying up your credit line, which may lower your credit score.
Care Credit is a type of medical credit card that can be used as a form of financing medical treatment or to pay out-of-pocket costs not covered by insurance. These cards are limited to medical procedures and often offer a 0% rate.
Home Equity Loan or a Line of Credit
If you have enough equity in your house, you could take out a home equity loan which often comes with interest based on current mortgage rates. This is usually an affordable option and is generally tax-deductible.
You can also take a personal loan from your bank or credit union. Banks usually have fixed interest rates, and a personal loan can help to boost your credit if paid off in a timely fashion.
Procedures that Medicare Will Cover
While Medicare won’t cover cosmetic surgery in most cases, there are a lot of services they will cover, such as:
- Rehabilitation services
- CT Scans
- Physical therapy
- Counseling services
- Oral surgery
- Pap smears
- Auto accident injury treatment
- Mental health services
- Pain management
- Hysterectomy surgery
- Gender reassignment surgery
- Hepatitis C testing
- Laser spine surgery
- Long-term care in a hospital or skilled nursing facility
- Genetic testing
- Liver transplants
- Chiropractic services
- Cataract surgery
- Hernia surgery
- Colonoscopy screenings
- Fertility treatments
- Palliative care
- STD testing
- Hospital observation
- Blood tests
- Outpatient surgery
- Air Ambulance transportation
- Dermatology services
- PET Scans
- ER Visits
- Allergy testing
- Annual physicals
- Home health care
- Thyroid tests
- Knee replacements
- Urgent care services
- Weight loss programs
- Breast reduction surgery
- Hip replacement surgery
- Back surgery
- Varicose vein treatment
- MRI Scans
- Macular degeneration treatment
- Eyelid surgery
- Heart transplants
- Cancer treatment
- Nutrition therapy
- Stem cell therapy