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Does Medicare Pay for Plastic Surgery?

doctor with patient - medicare may cover cosmetic procedure

Yes, medically necessary plastic surgeries are covered by Medicare, such as after injury, trauma, malformation, or breast cancer. You are still left with the normal out-of-pocket costs for these procedures, which include the deductible and copayments or coinsurance. These costs will differ for inpatient and outpatient procedures.

Medicare Plastic Surgery Coverage

Medicare Part A covers inpatient care in a hospital or skilled nursing facility. If you need reconstructive surgery after an injury or trauma, you will probably be admitted as an inpatient and this will be covered under Part A. Medicare Part B covers preventive care and medically necessary services. Reconstructive, medically necessary plastic surgery such as after an injury or trauma, to fix a malformation, or to reconstruct after breast cancer, is covered.

What Plastic Surgery Procedures Qualify for Medicare Coverage?

Medicare will cover surgery to repair damage after an injury or trauma. This can look like corrective surgery after damage to the extremities or complex injuries like burn damage. The skin often requires plastic surgery when major damage occurs.

Birth defects, like cleft palates, often require corrective plastic surgery to restore function. Medicare covers plastic surgery to repair a malformed body part to restore function. The dysfunction of these body parts can also be caused by aging, disease, and abnormalities in development. The return to proper use of these limbs is important to physical health, so these procedures are deemed medically necessary.

Breast cancer often requires the removal of tissue for biopsy, followed by the possibility of removing the tissue and glands making up the breast. Removing the breast is medically necessary. Breast reconstruction surgery is also considered medically necessary if the patient chooses to restore her figure for self confidence and emotional reasons. These surgeries can use prostheses or artificial implants or even the patient’s own healthy tissue.

Some procedures that Medicare covers fall under Medicare Part B as outpatient procedures, including rhinoplasty, cleft lip or palate, facial augmentation, breast reconstruction, and upper or lower limb surgery.

What Plastic Surgery Does Medicare Not Cover?

Medicare will not cover what is called cosmetic surgery. Cosmetic plastic surgery is an elective procedure that is not medically necessary. A procedure is determined to be medically necessary based on federal, state, and local laws, which help determine what is covered under Medicare. Cosmetic procedures include things like liposuction, body contouring, breast augmentation, breast lifts, face lifts, and tummy tucks—Medicare does not cover these.

What Are Your Costs After Plastic Surgery?

After plastic surgery, Medicare does not pay the full bill. You still have to pay your normal out-of-pocket costs. This will depend on whether your procedure was inpatient or outpatient. For an inpatient procedure, you pay a $1,484 deductible followed by the copayment they assign. For an outpatient procedure, you pay the $203 deductible and 20% of the Medicare-approved amount as copayment.

To learn more about the costs of Medicare and coverage for specific items, tests, and services, review Medicare’s helpful website. Teton Medicare is here to guide you and help you receive the health care services you need. Contact us today for assistance.

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