Plastic surgery procedures can address a wide range of conditions to improve a person’s function and quality of life. If you’re an Original Medicare beneficiary, you may be wondering if your benefits will cover plastic surgery. The answer is yes, but only in certain circumstances. Coverage for plastic surgery is determined on a case-by-case basis, and proper medical evidence and documentation must be provided to support the necessity of the surgery. In this article, we’ll help you understand the guidance and requirements set forth by Original Medicare for plastic surgery coverage.
Under what circumstances does Original Medicare cover plastic surgery?
To understand Original Medicare coverage for plastic surgery, it helps to know the difference between plastic surgery and cosmetic surgery. While these terms are often used interchangeably, they aren’t the same thing. Plastic surgery is a reconstructive practice that repairs bodily impairments caused by trauma, disease or development defects. Cosmetic surgery is an elective type of plastic surgery intended to enhance a person’s appearance.
In order for a plastic surgery to be covered by Original Medicare, it must be determined medically necessary by your doctor in order to treat a functional impairment or correct a deformity caused by injury, disease or a congenital condition. For this reason, Original Medicare does not cover elective cosmetic procedures like facelifts, breast augmentation, and liposuction.
Plastic Surgery Procedures Covered Under Original Medicare
While Original Medicare won’t cover elective plastic surgery for aesthetic purposes, there are a variety of procedures for which it offers partial or complete coverage. These include:
Reconstructive surgeries: Reconstructive surgeries, such as breast reconstruction following a mastectomy or surgery to repair facial abnormalities caused by accidents or trauma, may be covered by Original Medicare.
Surgeries to correct malformation or deformities: Original Medicare may provide coverage for plastic surgery if it is required to treat a functional impairment or correct a deformity caused by injury, disease or a congenital condition.
Rhinoplasties: Original Medicare may cover the cost of a rhinoplasty, also called a nose job, if you’re having trouble breathing due to a chronic nasal obstruction, injury or congenital defect.
Surgeries as a result of accidental injury: If you require surgery because of an accidental injury, it may be covered under Original Medicare to repair any visible trauma and improve functionality of the affected area.
Botox injections: Explain that while you may consider Botox to be a cosmetic procedure, doctors may also use it to treat severe migraines. In this case, Original Medicare may cover the cost of Botox injections.
Blepharoplasty surgeries: While Original Medicare doesn’t cover eyelid lifts for aesthetic purposes, it will cover blepharoplasty, a functional eyelid lift, if your sagging eyelids are significantly hindering your vision.
Unsure whether Original Medicare will cover a plastic surgery procedure? SelectQuote can help.
Navigating Original Medicare coverage and Medicare Advantage Plans can feel overwhelming, especially when it comes to plastic surgery procedures. Let SelectQuote help you find out what your policy covers so you can make informed decisions about surgeries and treatments. You can count on our experienced licensed insurance agents to help you make sense of your coverage, saving you time so you can access the care you need.
