Does Medicare Cover Plastic Surgery?

There are many reasons why you might need or want plastic surgery. The good news is that Medicare Parts A and B (known as Original Medicare) may cover plastic surgery if you need it for medical reasons.

In this article, we explain how Original Medicare pays for plastic surgery what out-of-pocket costs you may be able to expect.

If your plastic surgery is covered by Original Medicare, you may be able to find a Medicare Supplement Insurance (Medigap) plan that helps pay for some of your Medicare copays, coinsurance, deductibles and more.

What Is Plastic Surgery vs. Cosmetic Surgery?

Plastic surgery (sometimes referred to as reconstructive surgery) is a procedure your surgeon performs because it’s medically necessary, meaning you need it for medical reasons to improve your function or approximate a normal appearance. 

For example, you may need plastic surgery for medical reasons after an accidental injury, an infection, a tumor, malformation of a body part or other disease (e.g., breast cancer). 

Cosmetic surgery is a type of plastic surgery used to enhance the natural features of the body. Surgeons generally perform cosmetic surgery to reshape normal structures of the body to improve your appearance or enhance your self-esteem.

It’s important to distinguish between cosmetic and plastic surgery because Medicare doesn’t cover cosmetic surgery. It only covers medically necessary plastic (reconstructive) surgery.

What Are Examples of Medically Necessary Plastic Surgery That Medicare Covers?

Some examples of medically necessary plastic surgery covered by Original Medicare include:

• Treatment for severe burns
• Facial reconstruction or repair following a serious automobile accident
• Breast reconstruction after a partial or full mastectomy

What Are Examples of Cosmetic Surgery Medicare Does Not Cover?

Examples of plastic surgery that Medicare doesn’t cover include:

• Breast augmentation
• Breast lift
• Facelift
• Neck lift
• Laser hair removal
• Chemical peels

When you receive these and other elective cosmetic procedures, Medicare won’t cove your surgery and you’ll pay 100% of non-covered costs.

If a plastic surgery procedure is normally considered cosmetic but you need it for medical reasons, Medicare may pay for it if you obtain prior authorization. This means your doctor must send a prior authorization request to Medicare for approval before performing the procedure. 

If Medicare approves the request, you’ll pay your Medicare Part A and/or B deductible and coinsurance costs, depending on the setting of your plastic surgery, such as inpatient or outpatient.

One example of a cosmetic surgery that could be considered medically necessary by Medicare is blepharoplasty to remove excess tissue around your eye. You may need this procedure to improve your peripheral vision rather than for cosmetic purposes.

Other examples might include:

• Botox injections to treat a muscle disorder
• Panniculectomy (e.g., if excess skin from your lower abdomen causes chronic rashes)
• Rhinoplasty (e.g., to correct structural defects in your nose that impair your breathing)
• Vein ablation (e.g., when your veins cause pain, swelling, and ulceration) 

Only your doctor can determine whether your procedure is medically necessary.

How Much Does Plastic Surgery Cost With Medicare?

If Medicare covers your plastic surgery, you may be required to pay certain costs depending on where you receive your surgery.

For example, if you require breast reconstruction after a mastectomy, Medicare Part A would cover your hospital costs if the surgery takes place in an inpatient hospital setting. You would pay the Medicare Part A deductible. In 2024, the Medicare Part A deductible is $1,632 per benefit period. After you meet your Medicare Part A deductible, you may need to pay daily coinsurance costs if your hospital stay lasts longer than 60 days.

If your surgery takes place in an outpatient setting, Medicare Part B will help cover your costs. You would pay the Medicare Part B deductible. In 2024, the Medicare Part B deductible is $240. Once you meet this deductible, you’ll typically pay a 20 percent Part B coinsurance of the Medicare-approved amount for your surgery.

As mentioned above, a Medicare Supplement plan could help pay for some of these Medicare costs, such as the Part A deductibles, Part B coinsurance and more.

Does Medicare Supplement Insurance Cover Plastic Surgery?

If Original Medicare would cover the plastic surgery, then a Medicare Supplement – or Medigap – plan could help you save money on potentially high out-of-pocket Medicare costs like coinsurance and copays.

Speak with your doctor directly for specific plastic surgery costs and coverage information.

To learn more about how Medicare Supplement plans can help fill the “gaps” in Original Medicare, call to speak with a licensed insurance agent. You can compare plans available where you live, including their costs and coverage.