Does Health Insurance or Medicare Supplement Insurance Cover Plastic Surgery?
Even though we often associate beauty with youth, a recent Gallup survey indicates that we may have it backwards. According to Gallup, 66% of Americans aged 65 and older agreed that they always feel good about their physical appearance. But when it came to younger adults, only 61% of individuals between the ages of 18 and 34 could say the same thing (1).
Today, when people are not satisfied with their physical appearance or the signs of aging, they often have the technology and resources available to make a change. Over the past decade, the number of cosmetic surgeries performed on women increased by over 538%. Among men, that number increased by 325%. According to the American Society of Plastic Surgeons, men and women spent a combined $13.5 billion on plastic surgery in 2015 (2). Where is this money coming from?
Insurance is intended to cover the health care expenses of essential medical procedures, but health insurance policies can vary in terms of what they choose to cover. Nonetheless, most insurance providers adhere to a set of guidelines and definitions when deciding which procedures are considered necessary and which are considered elective. Typically, cosmetic procedures and plastic surgery are elective, but there are exceptions.
The same thing goes for Medicare and Medicare Supplement Insurance. While it may not seem like a large audience, the Gallup poll shows that there are those seniors who do not feel good about their appearance. There are also those seniors who need reconstructive surgery as a result of an accident or deformity. This makes it important to know what kind of procedures Medicare and Medicare Supplement Insurance will cover.
What kinds of plastic surgery qualify for health insurance coverage?
Health insurance companies and Medicare Supplement Insurance policies are more likely to cover reconstructive procedures than cosmetic ones. In other words, they will determine if the surgery is essential to bodily function or quality of life.
The American Medical Association’s (AMA) definition of reconstructive surgery is “surgery performed on abnormal structures caused by congenital defects, developmental abnormalities, trauma, infection, tumors, or disease.”
What kinds of plastic surgery do not qualify for coverage?
The AMA defines cosmetic surgery as “the reshaping of normal structures on the body to improve the self-esteem or appearance of a patient.”
Most insurance providers do not cover the health care expenses associated with cosmetic surgery because, by its very nature, this type of procedure is optional and is not necessary for normal bodily function.
Examples of cosmetic procedures that are not routinely covered include liposuction, breast augmentation, eyelid surgeries, or facelifts.
What are some surgeries that insurance companies will consider covering?
Some procedures that are typically performed for cosmetic purposes may be covered if the individual’s health is affected by a particular issue. Examples include:
”Nose job” – Some people get plastic surgery to change the shape of their nose simply because they don’t like the way it looks. Others alter their nose because the natural shape makes it hard to breathe. In this case, the surgery becomes necessary rather than cosmetic and may be covered by insurance.
Breast surgery – If a woman’s breasts are causing her pain or discomfort because of their size, her insurance company may consider covering the health care expenses of a reduction surgery.
Abdominal surgery – Though liposuction and tummy tucks are not usually covered by insurance, they may be considered if the issue is causing certain health problems like sores, rashes, or back pain.
Before any kind of surgery, you should always check with your health insurance company to make sure your health care expenses will be covered. Contact your insurance provider directly and get the details of your coverage in writing so that there are no surprises when your bill arrives.
- The Balance