I understand that Medicare does not cover cosmetic surgery, but that there are exceptions to this. I am in my early 70s and want to receive plastic surgery for my nose, mainly due to breathing problems. Is this still considered cosmetic? Are there Medicare Advantage plans that do cover this?
There’s a difference between cosmetic surgery and plastic surgery. Cosmetic surgery is a procedure performed chiefly to enhance appearance. Plastic surgery is 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.
Medicare does not usually cover cosmetic surgery but 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.
3. Malformation
Plastic surgery to improve the function and usefulness of a malformed body part may be covered under Medicare Part A and Part B.