Medicare does not cover plastic surgery when it is for cosmetic reasons only. Coverage may be available when plastic surgery is for reconstructive purposes.

Medicare is the federally funded health insurance program for adults over age 65. Those under 65 with certain health conditions may also qualify.

Part A covers costs relating to hospital stays. Part B covers outpatient care, such as diagnostics tests, doctor’s office visits, and some minor surgical procedures.

There are different types of plastic surgery, and Medicare may pay for elective procedures under specific circumstances.

This article looks at when Medicare may approve plastic surgery costs, when they may not, associated expenses, and more.

Glossary of Medicare terms

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.
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Generally, plastic surgery falls into two categories.

Reconstructive surgery

According to the American Society of Plastic Surgeons, reconstructive plastic surgery restores or corrects the appearance and function of a part of the body.

Disease, injuries, and developmental issues can all lead to changes that interfere with function and appearance.

Examples of reconstructive surgeries that usually have coverage from Medicare include:

Cosmetic surgery

In some cases, plastic surgery is strictly for appearance only and not part of treatment for a medical issue.

According to the American Academy of Cosmetic Surgery, cosmetic surgery enhances appearance through medical and surgical procedures.

Examples of cosmetic plastic surgery include:

Usually, Medicare does not cover plastic surgery.

Medicare covers plastic surgery when necessary to repair damage from an illness, accident, or due to a development issue with an area of the body.

In some cases, cosmetic and reconstructive surgeries may also overlap, but Medicare covers plastic surgery in the following examples.

Repair after an accidental injury

Crushed bones and burns can leave someone with injuries that affect appearance and function.

Medicare cover may include surgery to treat burns or facial reconstruction after an accident.

Breast reconstruction after a mastectomy

A mastectomy involves the removal of one or both breasts, usually as part of cancer treatment.

Breast reconstruction surgery involves different techniques to reshape or rebuild one or both breasts after mastectomy.

Usually, Medicare covers breast reconstruction.

Medically necessary cosmetic procedures

In many cases, the main and only focus of cosmetic surgery involves improving appearance.

For example, a rhinoplasty, also known as a nose job, may straighten a crooked nose or remove a bump.

Medicare will not cover a rhinoplasty when a surgeon performs it only for the improvement of appearance.

However, a person may sometimes experience difficulty breathing, and a nose job could be medically necessary to improve function.

Although a cosmetic benefit may occur due to the surgery, the main reason for the procedure is to improve the functioning of the nose.

In this case, if a cosmetic procedure is medically necessary, Medicare provides coverage.

Correction of a malformation

Medicare also pays for plastic surgery necessary to treat a development issue.

Certain development issues may lead to structural anomalies, which may affect both appearance and function.

For example, a cleft lip is present from birth and treatable with plastic surgery.

Medicare will only pay for medically necessary procedures, but whether coverage comes from Part A or Part B will depend on the setting of the surgery.

Part A covers medically necessary plastic surgery for inpatients. Coverage includes general nursing care, meals, and a semiprivate room.

Part B provides coverage for surgery in an outpatient setting.

A person’s doctor should be able to advise whether a procedure is an inpatient or outpatient service, which can help when managing out-of-pocket costs.

Exclusions for Medicare’s coverage of plastic surgery include procedures that surgeons perform entirely to improve the appearance without a medical need.

When Medicare covers plastic surgery, an individual may have some out-of-pocket expenses, such as deductibles and copayments. However, these will vary depending on whether coverage comes from Part A or Part B.

A person who needs hospital admittance for medically necessary plastic surgery will pay a $1,632 deductible in 2024.

Individuals who stay in the hospital for fewer than 60 days do not pay additional coinsurance.

Medically necessary plastic surgery in an outpatient setting and with coverage from Part B requires a person to pay a $240 deductible in 2024.

Part B also requires a person to pay a 20% coinsurance toward Medicare-approved costs.

Additional out-of-pocket expenses may vary according to the procedure and individual needs. For example, a copayment may exist for prescription pain medication necessary after surgery.

Medicare does not cover most alternatives to cosmetic plastic surgery.

Alternatives to cosmetic surgical procedures include injections, such as Botox and fillers.

Laser treatments, chemical peels, and microdermabrasion are also nonsurgical alternatives to plastic surgery. If these treatments are solely for altering appearance, they are ineligible for Medicare coverage.

Although Medicare does not cover these alternatives, the procedures are less costly, which may make them viable options for some people.

Alternatives for reconstructive surgery are available, and the options depend on a person’s circumstances. For example, if someone would prefer not to undergo breast reconstruction, wearing a prosthesis may be preferable.

Other insurance coverage options, such as a Medicare Advantage plan, do not provide an alternative way to have coverage for cosmetic procedures.

Typically, Medicare Advantage plans cover plastic surgery only if Original Medicare covers the procedure.

Medicare coverage for plastic surgery depends on the medical need for the procedure.

Plastic surgery can include reconstructive options that restore function and appearance due to an injury, development issues, or disease.

Medicare covers medically necessary reconstructive surgery but does not cover cosmetic procedures.

Out-of-pocket costs vary depending on which part of Original Medicare covers the service. A doctor can offer advice on this.

The same rules and exclusions for plastic surgery coverage apply to both original Medicare and Medicare Advantage plans.