Cosmetic surgery is a multi-billion dollar industry, with some surgeries costing thousands of dollars per procedure. There are many reasons why you may be considering cosmetic surgery, but the price may be prohibitive. If you’re enrolled in Medicare, is cosmetic surgery ever covered? If so, how much coverage can you expect?
Is Cosmetic Surgery Ever Covered by the Medicare Program?
In most cases, the Medicare program does not cover cosmetic surgery. This is because it’s often considered an elective surgery or a procedure that isn’t necessarily for a life threatening condition and can be scheduled in advance. While cosmetic surgery can be done to improve quality of life and can be important, in many cases, it’s generally optional or not considered medically necessary. For those who are familiar with the ins-and-outs of Medicare insurance coverage, this is generally the key factor in whether something is covered or not.
If the Medicare program approves the prior authorization, your cosmetic surgery should be covered by Medicare Part B as outpatient surgery.
There are some cases where the Medicare program may cover cosmetic surgery; this is when your doctor has decided that it’s medically necessary and you receive prior authorization. If the Medicare program approves the prior authorization, your cosmetic surgery should be covered by Medicare Part B as outpatient surgery. You should only need to meet your Part B deductible and pay a 20 percent coinsurance.
What Qualifies as Medically Necessary?
Since the medical necessity of a cosmetic surgery is critical to it being covered by Medicare, it’s important to know when that surgery would be considered “medically necessary.” If you want a cosmetic surgery to “fix” a physical aspect of yourself, anticipating it’ll help your self-esteem and mental health, that generally doesn’t satisfy the demands of medical necessity. Instead, a cosmetic surgery may be covered by Medicare if it’s related to an injury or accident or to improve a function of your body. Think of it this way: If your breathing is impacted due to a deviated septum from a broken nose or because it didn’t develop properly, you may have a rhinoplasty covered. The Medicare program will also cover breast prostheses following a mastectomy.
A cosmetic surgery may be covered by the Medicare program if it’s related to an injury or accident or to improve a function of your body.
If your procedure is considered medically necessary, the service provider will submit a prior authorization request for approval. Once this request is approved, your procedure can go ahead.
Are There Other Options?
Let’s say your procedure won’t be covered by the Medicare program. Do you have other options?
Generally speaking, insurance will not cover cosmetic surgery unless it’s medically necessary. This includes many privately-offered Medicare insurance plans like Medicare Advantage (Part C) and Medicare Part D.
Some cosmetic surgeons will offer payment plans or discounts, but this will also vary. If you’re interested in cosmetic surgery, it’s worth exploring your options with surgeons who perform cosmetic services in your area to see what savings and payment options are available to you.
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Whether you’re enrolled in the Medicare program or private insurance, the situations where you may have your cosmetic surgeries covered by your plan are rare. These surgeries aren’t considered medically necessary unless they fit into specific circumstances. Despite this lack of coverage, cosmetic surgery remains popular, with millions performed each year. If you’re exploring your cosmetic surgical options, it’s worth discussing them with your doctor to determine if they fit the criteria to receive coverage. If not, you can see what savings or payment options are available near you.
