According to the American Association for Retired Persons (AARP), someone becomes eligible to enroll in Medicare insurance every eight seconds. If you are one of them, or if you are assisting a loved one who qualifies for Medicare, you may already know some of the basics of Medicare, but you may have questions about Medicare coverage for plastic surgery.
Defining Plastic Surgery for Medicare Coverage
Plastic surgery in itself can be a confusing area of medical treatment. The terms plastic surgery and cosmetic surgery are often used interchangeably, but according to the American Board of Cosmetic Surgery (ABCS), there are important differences to be aware of. The ABCS defines cosmetic surgery as a procedure performed chiefly to enhance appearance.
The American Society of Plastic Surgeons (ASPS) defines plastic surgery as a “reconstructive procedure,” or a procedure performed chiefly to reconstruct an area that is malformed or has become damaged to restore normal appearance and function.
The ASPS also points out cosmetic surgeons and plastic surgeons receive different education and training for these different specialties. Can cosmetic surgery and plastic surgery overlap? They can, and your particular case will determine whether Medicare will cover any part of your plastic surgery procedure.
Will Medicare Pay for Cosmetic Surgery?
Medicare does not usually cover cosmetic surgery, however, there are important exceptions. Cosmetic surgery procedures may be considered medically necessary when prescribed by a physician to improve function or repair damage or malformation.
Medicare insurance will cover plastic surgery under the following specific conditions:
1. Breast reconstruction following mastectomy
Breast reconstruction following cancer treatment is considered plastic surgery rather than cosmetic surgery. Many breast cancer patients who have undergone a partial or full mastectomy (breast tissue removal) wish to have the area repaired via breast prostheses, whether internal or external. If a cancer patient wishes to have reconstructive surgery following treatment for breast cancer, their care may be covered under Medicare Part A and Part B.
2. Accidental injury
If you have experienced an accidental injury that has caused trauma and damage to a body part or area, Medicare Part A and Part B may help cover plastic surgery to repair the damage.
Plastic surgery to improve the function and usefulness of a malformed body part may be covered under Medicare Part A and Part B.
How Does Medicare Advantage Differ from Original Medicare?
Many Medicare recipients get their benefits through Medicare Advantage plans offered by private insurance companies who contract with Medicare to provide your Part A and Part B benefits. Medicare Part C plans are required to provide at least the same coverage as Original Medicare, but many offer additional coverage. Contact your plan directly to find out your exact costs for your plastic surgery procedure.