Medicare does not cover liposuction surgery that people undergo for cosmetic reasons. However, if a doctor confirms that liposuction is medically necessary to improve a person’s bodily function, Medicare may cover eligible costs.
Some people who wish to lose weight consider undergoing liposuction. However, most people lose only 2–5 pounds after having the procedure.
Those who choose to go ahead with the surgery may need to pay out of pocket.
We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:
- Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
- Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
- Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Medicare does not cover cosmetic liposuction, which people often refer to as lipo, as it is generally an elective procedure. Most private medical insurance plans also have this policy.
However, Medicare may cover medically necessary liposuction when a doctor advises that the procedure may help repair part of the body.
The part of Medicare that covers medically necessary liposuction will depend on where the procedure takes place.
Doctors perform many cosmetic surgeries on an outpatient basis, but for medically necessary surgeries, a person may need to stay in the hospital.
Before going ahead with the procedure, a person can check with their healthcare provider and Medicare to confirm coverage and avoid additional costs.
Medicare Part A
If a doctor recommends hospital admission for liposuction, Part A will cover eligible costs. Part A helps with expenses associated with hospital, skilled nursing facility, or hospice care.
Medicare Part B
Although the surgery may take place in the hospital, insurance providers may still consider it an outpatient procedure. Part B covers outpatient services and treatments in a hospital, doctor’s office, or clinic.
When a person receives medically necessary liposuction as an outpatient, Medicare Part B will cover eligible expenses.
Medicare Advantage
Medicare Part C, also called Medicare Advantage, covers the same benefits as original Medicare parts A and B.
Medicare Advantage plans typically offer additional benefits, but their coverage does not extend to cosmetic liposuction.
Liposuction is a surgical procedure that reshapes specific areas of the body and is one of the most common cosmetic surgeries in the United States.
It works by removing fat deposits from a person’s chosen area or areas of the body. These areas may include the:
- belly and waist
- back
- calves and ankles
- cheeks, chin, and neck
- chest area
- hips and buttocks
- inner knee
- thighs
- upper arms
After the procedure, a person may have swelling, bruising, and soreness in the treated area. The recovery time can last up to 6 weeks.
Obesity and liposuction
Cosmetic liposuction may work alongside other therapies. Although a person may hope that liposuction can help with obesity, it cannot take the place of diet and exercise.
Cellulite and liposuction
Cellulite appears when fat pushes against bands of tissue in the skin, causing dimples and bumps.
Liposuction is not an effective remedy for cellulite as the procedure only removes the fat tissue and not the bands of tissue that cause cellulite.
People may wish to have liposuction for
Cosmetic
A person may look to liposuction to address areas of their body that have not responded to diet and exercise. They may not be happy with the appearance of these parts of the body.
A doctor may perform cosmetic liposuction to remove fat from the belly, thighs, or upper arms. However, this type of therapy is not medically necessary.
Medically necessary
If a person sustains serious injuries, a doctor may recommend medically necessary liposuction to improve or restore the function of the affected part of the body.
Doctors may also state that liposuction is medically necessary for:
- repairing the breast after a mastectomy for breast cancer
- removing fat deposits from the legs in people with lymphedema to improve mobility
- transferring fat from one area to another in people with a severe injury or burn
If the surgery is not medically necessary, a person will pay all expenses themselves. When liposuction is medically required, Medicare Part A and Part B may still have some out-of-pocket costs.
Part A
In 2021, a person’s Part A out-of-pocket costs may include a $1,484 deductible for every benefit period and a daily copayment after 60 days in a hospital or skilled nursing facility.
Most people do not pay a premium for Part A. However, if they do, it can be up to $458 per month.
Part B
The 2021 out-of-pocket costs for Medicare Part B include:
- a monthly premium, for which the standard amount is $148.50
- a yearly deductible of $203
- 20% coinsurance for eligible costs
If a person has difficulty paying healthcare costs, some programs may be able to help. These include:
- Medicare supplement insurance: Also called Medigap, these plans may help cover coinsurance and the Medicare Part A deductible.
- Medicaid: This federal and state program helps with medical costs when a person has limited income.
- Medicare savings programs: These state programs help a person pay premiums, deductibles, coinsurance, copayments, and prescription drug costs.
- Supplemental Security Income (SSI): This monthly benefit for people with limited income is not the same as Social Security retirement or disability benefits.
Medicare does not generally pay for liposuction. However, the program may pay for the procedure when it is medically necessary to restore function after an incident or illness.
Either Part A or Part B pays for medically necessary liposuction, depending on the setting in which the procedure takes place. Part A pays for inpatient care, whereas Part B pays for outpatient services.
Liposuction requires recovery time, and a person may not be able to resume strenuous activity for up to 6 weeks.
Individuals with limited income and resources have several support options to help them pay for their healthcare needs.