Quick Answer
Medicare does not cover elective cosmetic surgery. However, medically necessary plastic surgery - such as breast reconstruction after mastectomy, repair after accidental injury, rhinoplasty for breathing issues, or blepharoplasty - may be covered after prior authorization.
Coverage Comparison by Plan Type
| Plan Type | Coverage | Notes |
|---|---|---|
| Original Medicare (Part A) | Covered (inpatient) | Covers medically necessary inpatient reconstructive surgery |
| Original Medicare (Part B) | Covered (outpatient) | Covers outpatient procedures at 80% after deductible |
| Medicare Advantage | Covered | Must cover same as Original Medicare; may require referrals |
| Medigap | Covers Cost-Sharing | Covers Part A deductible and Part B 20% coinsurance |
| Medicare Part D | Rx Coverage | Covers post-surgical medications |
Understanding Your Coverage Options
Original Medicare (Part a & B)
Original Medicare covers medically necessary plastic surgery but does not cover elective cosmetic procedures. Part A covers inpatient surgical stays, while Part B covers outpatient procedures at 80% after the deductible.
Prior authorization is required for all plastic surgery claims. Your physician must submit medical records to a Medicare Administrative Contractor (MAC) proving the procedure is medically necessary. This process can take two or more weeks.
Covered procedures include breast reconstruction after mastectomy, repair after accidental injury, rhinoplasty for breathing problems, blepharoplasty for obstructed vision, vein ablation, and Botox for migraines or muscle spasms.
What It Covers
- Breast reconstruction after mastectomy (including prostheses and surgical bras)
- Reconstructive surgery after accidental injury or disease
- Rhinoplasty for breathing issues or congenital defects
- Blepharoplasty for obstructed vision or nerve palsy
- Botox injections for severe migraines or muscle spasms
- Tummy tuck if medically necessary after extreme weight loss
What It Doesn't Cover
- Elective cosmetic surgery (facelift, breast lift, body contouring)
- Procedures solely to alter appearance
- Plastic surgery after Mohs surgery (in most cases)
Part A: $1,736 deductible per benefit period (2025). Part B: 20% coinsurance after $283 annual deductible.
Medicare Advantage (Part C)
Medicare Advantage plans must cover everything Original Medicare covers, including medically necessary plastic surgery. However, plans may have different cost-sharing structures, network requirements, and may require referrals or additional prior authorization steps.
Some Medicare Advantage plans may offer additional benefits or more streamlined approval processes. Always verify that your surgeon and facility are in-network to avoid higher out-of-pocket costs.
Medicare Supplement (Medigap)
Medigap plans help cover the out-of-pocket costs left after Original Medicare pays its share. For medically necessary plastic surgery, a Medigap plan can cover the Part A deductible, Part B coinsurance (20%), and other cost-sharing amounts.
Plans like Medigap Plan G cover nearly all cost-sharing, meaning you could pay little to nothing out-of-pocket for approved reconstructive surgery beyond your monthly premium and the Part B deductible.
Medicare Part D
Medicare Part D covers prescription medications you may need following plastic surgery, such as pain medications, antibiotics, and anti-inflammatory drugs. Your out-of-pocket costs depend on your plan's formulary and which tier your medications fall under.
Plastic Surgery Cost Estimates with Medicare
| Procedure | Typical Cost Range | Medicare Coverage |
|---|---|---|
| Breast reconstruction after mastectomy | $5,000 – $15,000+ | Covered (Part A/B) |
| Rhinoplasty (medically necessary) | $5,000 – $10,000 | Covered with prior auth |
| Blepharoplasty (eyelid surgery) | $3,000 – $7,000 | Covered if medically necessary |
| Abdominoplasty (tummy tuck) | $6,000 – $12,000 | Covered if medically necessary |
| Botox for migraines | $300 – $600 per session | Covered under Part B |
| Elective facelift | $7,000 – $15,000 | Not covered |
✦ Important Exceptions & Prior Authorization
Prior Authorization is Required
Prior authorization is required for all medically necessary plastic surgery. Your physician must submit records to a Medicare Administrative Contractor for approval before the procedure.
Tummy Tuck Requires 6-month Weight Stability
To qualify for a tummy tuck after weight loss, you must maintain stable weight for at least 6 months and try non-surgical treatments for at least 3 months.
Breast Reduction Requires 6 Months of Symptoms
Medicare requires documented symptoms (neck/back pain) for at least 6 months and failed non-surgical treatments before covering breast reduction surgery.
Mohs Surgery Reconstruction Usually not Covered
Original Medicare typically does not cover reconstructive plastic surgery after Mohs surgery for skin cancer removal, though the Mohs procedure itself is covered.
Denied Claims Can be Appealed
If your prior authorization is denied, your physician may submit additional documentation. You may also need to sign an Advance Beneficiary Notice acknowledging potential non-coverage.
Each MAC Decides Independently
Each Medicare Administrative Contractor can independently determine the medical necessity of a procedure, so coverage decisions may vary by region.
✦ Frequently Asked Questions
David Haass
AuthorDavid Haass is a licensed Medicare expert and member of the Forbes Finance Council who has been helping beneficiaries navigate their Medicare options.
Ashlee Zareczny
ReviewerAshlee Zareczny is a licensed Medicare agent in all 50 states dedicated to educating those eligible for Medicare.