Are droopy eyelids making it hard for you to see well? If so, it’s possible that your physician has mentioned blepharoplasty to relieve the problem that this sagging skin is causing.
Blepharoplasty is one of the top five plastic surgical procedures performed in the United States for both men and women, and it is becoming more and more common every year. Many people have eyelid surgery for cosmetic reasons, but it is more commonly done for reconstructive or functional reasons.
Your Medicare benefits may cover blepharoplasty if your procedure is being done to eliminate excess skin that is causing health or vision problems. Here’s what you need to know before you make your decision about having blepharoplasty.
What Is Blepharoplasty?
Blepharoplasty, or eyelid surgery, is a procedure done by a surgeon to remove excess skin and sometimes muscle and fat from eyelids that are drooping. It can be done on upper and lower eyelids. Eyelids begin to droop as people age because the skin stretches, and the supporting muscles lose their efficiency. Excessive sagging can impair vision and hinder the eye from properly opening or closing.
The procedure is commonly performed in an outpatient setting. Depending on your circumstances and the recommendations of your surgeon, you can have local or general anesthesia.
Full recovery from blepharoplasty usually takes several weeks, but stiches come out after 2-7 days. Redness and swelling are common after surgery and patients should let their eyes rest well during recovery. Health care providers advise that you don’t do any bending or heavy lifting for a couple weeks after your procedure.
Who should have reconstructive blepharoplasty? Your health care provider may have suggested having eyelid surgery if you have any of the following medical reasons:
• Impaired vision from sagging skin that makes driving or other tasks difficult.
• Irritation or rubbing caused by excess skin on eyelids.
• Eyelid complications due to thyroid disease or another condition.
• Muscle strain as a result of lifting sagging skin in the eye region.
• Previous injury that has caused a defect to the eyelid.
Medicare Benefits for Blepharoplasty
If your eyelid surgery is medically necessary to improve function or ability, it is considered reconstructive surgery. Because blepharoplasty is generally an outpatient procedure, it may be covered by Original Medicare Part B (Medical Insurance), or Medicare Advantage (Part C). If the eyelid surgery is for cosmetic purposes, Medicare recipients do not have coverage.
Under Original Medicare Part B, you are responsible for your yearly deductible of $185 (in 2019) and coinsurance payments. Under Medicare Advantage, the benefits and costs of medically necessary blepharoplasty depend on your individual insurance plan, so carefully review your policy for the details.
It is difficult to determine what your final cost for blepharoplasty will be in advance. You can estimate the cost by discussing your situation with your health care provider and by taking the following factors into consideration:
• The cost of the doctor, hospital, or facility for the surgery and after-care.
• The type of outpatient facility.
• Whether you have the procedure as an inpatient or outpatient.
• What types of coverage you have.
Before approving coverage, Medicare considers the following factors when determining if blepharoplasty is medically necessary:
• The amount of excess skin on the upper eyelid that is physically visible.
• Proof from an ophthalmological examination that you have a minimum of 30 percent, or 12
degrees, of visual field obstruction.
• Photographic evidence taken before surgery, and documentation of a visual problem.
• The recommendation of a physician who has reviewed your individual case.
In the United States the average cost of blepharoplasty is just over $3000, but prices do range greatly depending on where you live, your surgeon’s experience, and the exact procedure. There are other costs involved in this procedure that you need to take into consideration. They include facility or hospital fees, anesthesia fees, medical testing before the procedure, and any prescriptions for medication.
Medicare recipients can get coverage for blepharoplasty if they are eligible. If you are considering this procedure, make sure you discuss all the details with your physician and policy provider so you can make an informed decision.