Original Medicare does not provide coverage for procedures that are not medically necessary.
This is especially true for cosmetic surgeries because these procedures are usually done for cosmetic purposes. Yet, some plastic surgeries are medically necessary and are considered as such by Medicare. This leads to some confusion over what is covered and what isn’t.
If you are considering a procedure that falls into this category, it’s likely you have the common question, “does Medicare cover plastic surgery?”
In this article, we answer that question in clear, plain English. You will also find the average costs of plastic surgery if you have to pay out-of-pocket.
Does Medicare Cover Plastic Surgery?
Most of the time the answer to this is no. Medicare does not cover the cost of plastic surgery. That said, there may be some situations where you can get these costs covered. Below we’ll take a closer look at this to see when you might be able to get Medicare to pay for your plastic surgery.
Original Medicare Coverage of Plastic Surgery
Original Medicare (Medicare Part A and Part B) does not provide coverage for plastic surgery. That means you will have to pay 100 percent for your plastic surgery. Original Medicare does not provide coverage for plastic surgeries if they are done for cosmetic reasons or non-medically necessary reasons.
However, in some cases, Original Medicare provides coverage for plastic surgeries. Original Medicare provides coverage for plastic surgeries if they are done for a medically necessary reason, such as repairing a function of a body part.
This plan also provides coverage for breast reconstruction after a mastectomy for breast cancer.
Original Medicare provides coverage for the following plastic surgery procedures:
- Cleft lip or palate surgery
- Facial augmentation
- Prosthetic or tissue flap breast reconstruction
- Upper or lower limb surgery
- Surgery to repair injuries after burns or trauma
When Part A Covers Costs
For covered plastic surgeries, coverage for plastic surgery is provided by Medicare Part A if it takes place in an inpatient setting. Medicare Part A will cover 100 percent of the costs of hospital stays for up to 60 days. For days 61 to 90, Medicare Part A will still provide coverage. However, you will pay a copayment for each day you are in the hospital. After 90 days, Medicare Part A will no longer provide coverage.
But Medicare Part A does provide 60 lifetime reserve days. If you have them, they will still provide coverage for your hospital stay after 90 days. But, again, there will be a daily copayment that you are responsible for.
When Part B Covers Costs
On the other hand, coverage for plastic surgery is provided by Medicare Part B when it takes place in an outpatient setting. Once approved, Medicare Part B covers 80 percent of the costs of plastic surgery. You will pay for the remaining 20 percent.
Part C Coverage for Plastic Surgery
Like with Original Medicare, Medicare Advantage plans (Medicare Part C) also do not cover plastic surgeries that are not medically necessary. Medicare Advantage plans must cover everything Original Medicare covers but will offer some additional benefits too.
What a plan will cover and how much you’ll pay for that additional coverage will vary depending on your plan. That said, it’s very unlikely you’ll find a plan that covers plastic surgery.
How Much Does Plastic Surgery Cost?
The cost of plastic surgery usually ranges between $3,000 and $15,000 when you pay for it out-of-pocket. These costs can vary widely depending on the type of plastic surgery you get.
Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage. Always be sure to double check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.
Additional Info on Medicare Coverage
This article is part of our series on “What does Medicare cover?”
Also, you can check out other articles in this series, including: Does Medicare Cover Pelvic Floor Therapy?