Does Medicare Cover Plastic Surgery?

The short answer is no, Medicare does not cover plastic surgery if it is done purely for cosmetic reasons to improve your appearance. However, Medicare Part B will cover plastic surgery if it is deemed medically necessary to repair function or correct a deformity caused by an accident, injury, or disease.

When it comes to Medicare, the line between cosmetic and reconstructive surgery is drawn entirely by medical necessity. If you are looking for a facelift, a tummy tuck, or liposuction just to look younger or thinner, you will be paying out of pocket. Medicare is designed to protect your health, not your vanity.

But if you have suffered a severe burn, been in a car accident that caused facial trauma, or need breast reconstruction after a mastectomy for breast cancer, Medicare steps in. In these cases, the surgery is considered reconstructive rather than cosmetic. The goal is to restore normal function or a normal appearance that was lost due to a medical condition or trauma.

If your surgery is covered, it falls under Medicare Part B (Medical Insurance) if performed as an outpatient procedure, or Part A (Hospital Insurance) if you are admitted as an inpatient. You will still be responsible for your Part B deductible and the 20% coinsurance, unless you have a Medicare Supplement plan to fill those gaps.

This is where understanding the two paths of Medicare becomes critical. The real choice isn't between a supplement and an Advantage plan; it's between Traditional Medicare (Parts A and B) and Medicare Advantage. If you choose the Traditional path, a Medigap policy fills the gaps by law. You don't want to be fighting with an insurance company over whether your reconstructive surgery is covered while you're trying to recover. You want straight answers, no surprises.

To ensure your surgery is covered, your doctor must document the medical necessity clearly. This means providing evidence that the procedure is required to treat an illness or injury, or to improve the functioning of a malformed body member.

For example, rhinoplasty (a nose job) is generally not covered. But if you have a severe deviated septum that is causing significant breathing problems, Medicare may cover the surgery to correct the functional issue. Similarly, eyelid surgery (blepharoplasty) is cosmetic unless drooping eyelids are severely impairing your vision, which must be proven with a visual field test.

If you are considering a procedure that might blur the line between cosmetic and reconstructive, it is crucial to have your doctor send for an advance beneficiary notice (ABN) or pre-authorization if you are on a Medicare Advantage plan. This will tell you upfront whether Medicare will foot the bill.

Don't leave your coverage to chance. We walk you through every option so you know exactly what to expect. Your dollars are votes, and you deserve to spend them wisely.