Medicare may cover the costs of plastic surgery when a doctor or plastic surgeon deems it medically necessary. However, it does not cover plastic surgery for cosmetic purposes only.

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

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

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

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 Medicare covers 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 aims to enhance appearance through medical and surgical procedures.

Examples of cosmetic plastic surgery include:

Common cosmetic procedures that Medicare may cover

Sometimes, Medicare may cover cosmetic surgical procedures that doctors consider medically necessary. Examples include:

  • Panniculectomy: This procedure removes lower abdominal skin when it overhangs and causes sweat and rashes. Medicare may cover the procedure when other measures to manage the rashes have been ineffective. It is not a full tummy tuck but removes some of the skin that a tummy tuck would address.
  • Breast reduction: A breast reduction reduces breast size by removing skin and breast tissue. It can be medically necessary if a person has documented back, neck, or shoulder pain, grooving from the bra straps, or rashes under the breasts. Additionally, for most insurers to cover this surgery, surgeons must remove a certain amount of breast tissue relative to a person’s body mass index (BMI).
  • Blepharoplasty: This procedure removes extra skin from a person’s upper eyelids. Insurers may cover this procedure when extra eyelid skin blocks the individual’s upper field of vision.

It may cover plastic surgery when it becomes necessary to repair damage from an illness, accident, or due to a development issue with a bodily area.

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. In these circumstances, Medicare covers breast reconstruction.
  • Medically necessary cosmetic procedures: Medicare will not cover a rhinoplasty when a surgeon performs it only to improve appearance. However, a person may sometimes experience difficulty breathing, and a nose job could be medically necessary to improve function. In this instance, Medicare may cover costs.
  • Correction of a malformation: Specific development issues may lead to structural anomalies, affecting appearance and function. For example, a cleft lip that is present from birth may be treatable with plastic surgery. Medicare may cover costs relating to these anomalies.

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

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

Part A

Part A covers medically necessary plastic surgery for inpatients. Coverage includes general nursing care, meals, and a semiprivate room. A person who needs to undergo medically necessary plastic surgery will pay a $1,676 deductible in 2025.

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

Part B

Part B provides coverage for surgery in an outpatient setting. Medically necessary outpatient plastic surgery requires a person to pay a $257 deductible in 2025.

Part B also requires individuals 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, there may be a copayment to pay for prescription pain medication that is necessary after surgery.

Medicare does not cover most alternatives to cosmetic plastic surgery.

Other approaches to cosmetic surgical procedures include injections, such as Botox and fillers, although Medicare may cover Botox in some instances.

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.

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

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

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

Out-of-pocket costs vary depending on which part of Original Medicare covers the service.

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