Your Guide to Medicare and Plastic Surgery
Medicare can be challenging to understand, especially when it comes to plastic surgery. Some procedures are purely cosmetic, while others are medically necessary. How does Medicare treat these intricacies?
We met with Dr. Michael Neumeister, MD, Professor and Chairman of the Institute of Plastic Surgery at the Southern Illinois University School of Medicine, Springfield, IL.
Dr. Neumeister explains what procedures are most common after age 65, what Medicare will cover, and he also has some must-read tips about aging and plastic surgery.
The Medicare Checklist for Ages 66+
Most Medicare info on the web is for those who are new to Medicare. But what about those of us who are seasoned consumers? There’s a few things to know, and this short guide will walk you through them.Get Yours Free
Functional vs. Cosmetic Plastic Surgery
Plastic surgery is divided into two categories:
- Reconstructive surgery, or medically necessary procedures required for a functional reason
- Cosmetic work, or procedures you want for the cosmetic effect, such as looking younger
Often, a procedure you’d think is purely for looks – like a facelift – can be done for medically necessary reasons. Understanding if surgery is cosmetic or functional is critical, especially regarding how much you’ll pay.
All insurances – including Medicare, Medicare Supplements, and Medicare Advantage – will not cover cosmetic plastic surgery. If you want a cosmetic procedure done, you’ll be paying out of pocket.
While it seems like the line between cosmetic and medically necessary could be blurry, Dr. Neumeister says that’s not the case:
“We get a detailed history from the patient explaining exactly why they’re there to see us. The concern needs to be a functional impairment for us to even think about sending it to the insurance. It wouldn’t be fair or honest for us to send it to insurance if we knew it really wasn’t a medical problem.”
Plastic Surgery After Age 65
Some of the most common procedures done after age 65 include the following:
- Facelift, or rhytidectomy
- Neck lift, or lower rhytidectomy
- Joint replacement, such as arthroplasty
- Eyelid surgery, or blepharoplasty
- Nose job, or rhinoplasty
While some of these surgeries sound purely cosmetic, Dr. Neumeister explains it isn’t that simple. For example, a droopy eye can impair vision, and a misshapen nose can impact breathing. If a procedure is medically necessary, Medicare and other insurance programs will likely cover it.
Botox and Injections
One of the most common reasons older adults see a plastic surgeon is for laxity in the skin. Between the ages of 40-65, fillers, like Botox injections, can help patients achieve some rejuvenation.
After age 65, Dr. Neumeister says surgery – such as a facelift – is more common because the skin's laxity requires more than just filler.
However, injections can help with muscle disorders, spams, and twitches. Medicare considers these injections medically necessary, so as long as you get prior authorization, they will be covered.
Facelifts and Neck lifts
Many older adults come to Dr. Neumeister with concerns about jowls or redundant skin in the neck.
“That’s very common after age 65,” he says. “A lot of people want the contour of the chin to neck back to the way it was when they were 30 or 40. A neck lift or a combination of a facelift and neck lift can do that.”
Wanting to turn back time is cosmetic, but there are certainly times with a facelift or neck lift is medically necessary. For example, if you had a stroke or part of your facial nerve that usually allows you to smile isn’t functioning, your face can be droopy.
Your surgeon can also do a one-sided facelift, also called a unilateral facelift, which helps when only one side of the face is drooping. A one-sided facelift can help with drooling, the inability to smile, speech impairments, and even trouble breathing.
Dr. Neumeister takes a thin muscle from the leg and hooks it up to facial nerves. It takes about two months to get your smile back, and it involves microsurgery.
“When a patient looks in the mirror and can smile again, it brings tears to their eyes. That makes it all worth it,” he says.
If a facelift or neck lift is medically necessary – even if you get cosmetic benefits as a result – Medicare and other insurances like Medicare Advantage should cover it.
Joint Replacements and Arthritis
Outside of cosmetics, the most common medically necessary procedures done relate to arthritis.
“We deal with a lot of arthritis in joints, the hand, and the wrist,” Dr. Neumeister says. Surgeons often do joint replacements to remedy arthritis. Joint pain, swelling, and stiffness, especially in the fingers and hands, can be helped by a plastic surgeon.
Procedures like arthroplasty, arthroscopy, and synovectomy can help restore proper alignment and function in your joints. As long as the surgery is medically necessary, Medicare will pay its portion.
Sometimes, excess skin hanging on the upper eyelids can impair your visual field. Your optometrist or eye surgeon will document that and confirm if removing that skin is medically necessary to improve your vision.
Eyelid surgery to remove droopy, fatty, or excess tissue around the eyes is called blepharoplasty, and as long as you get prior authorization, Medicare will cover its portion.
If excess skin around the eyes isn’t medically necessary, and you just want to look younger, that’s a purely cosmetic procedure. Medicare and all other insurances do not cover cosmetic plastic surgery, Dr. Neumeister explains.
Rhinoplasties or Nose Jobs
Dr. Neumeister explains that most rhinoplasties, or nose jobs, are purely cosmetic. However, for folks over age 65, there’s more likely to be a functional component.
“Breathing problems can happen over time because of working the septum of the nose,” he explains. “Improving the airways is probably the most common reason for a rhinoplasty after age 65.”
And yes – improving the airways is a medically necessary procedure and thus would be covered by Medicare.
Medicare and Plastic Surgery
If plastic surgery is medically necessary, Dr. Neumeister says Medicare is pretty good about covering it. Everything from eyelid surgery to a facelift can be done for functional reasons, meaning Medicare would cover it.
Medicare clearly states it will cover breast prostheses for breast reconstruction if you had a mastectomy because of breast cancer. Medicare categorizes most other procedures under “accidental injury” or the “improved function of a malformed body part.”
Also, for most plastic surgery, Medicare requires prior authorization before it will cover its portion.
If there’s no functional reason to have a procedure done, you will pay your plastic surgeon out of pocket.
In places like New York or California, plastic surgeons charge more because they have patients willing to pay the high price tag. However, in central Illinois, Dr. Neumeister explains surgeons are very reasonable.
“Plastic surgeons who do cosmetic work are reasonable about how many hours it takes and how complex the procedure is. They use an equation to come up with their price,” he says.
For example, a facelift can range from $5,000 to $20,000 – the high end is an example of what you’d find in New York or California.
Medicare Advantage and Plastic Surgery
Medicare Advantage (Part C) plans must cover what Original Medicare covers. If Medicare would cover a procedure, your Medicare Advantage plan would also help pay for it. However, Medicare Advantage plans are not standardized, so each plan has its own set of costs.
Your costs will depend on your specific plan’s deductible, coinsurance, and copays. Typically, your out-of-pocket costs with a Medicare Advantage plan will be higher than Original Medicare with a supplemental plan.
Medicare Supplements and Plastic Surgery
Medicare Supplements help pay the extra costs left behind by Medicare. That includes your deductibles and coinsurance.
If you need medically necessary plastic surgery, your supplement will pick up all or most of the costs left by Medicare.
Plastic Surgery Advice for Older Adults
If you need plastic surgery – whether it’s for functional reasons or purely cosmetics – Dr. Neumeister has a few tips.
1. See a Board-Certified Surgeon.
Ensure the doctor is board certified by the American Board of Plastic Surgery. Being board certified is a voluntary credential, but it ensures your surgeon has completed the appropriate training and examinations for all plastic surgery procedures.
You can determine if your surgeon is board certified by entering their first and last name in the American Board of Plastic Surgery website search. If the first and last name doesn’t get you any results, try the city and state search.
2. See an Experienced Surgeon.
Dr. Neumeister advises asking the surgeon how many cases they do. “You want expertise. If they say they’ve done one before, you want another opinion if someone has more experience,” he says.
That said, experience isn’t everything. Dr. Neumeister explains you may click well with a surgeon and feel very comfortable with them. You may find a surgeon that did 50 procedures in the last year or someone who is just fantastic and has an excellent reputation.
What matters most is that you’re comfortable with your surgeon.
3. Ask About Surgery Risks and Complications
Everyone should ask: what’s the downside of this surgery?
Dr. Neumeister says every surgeon should be able to through the potential complications and risks that could arise.
4. Bring a Support System to Appointments
“I love it when people come to me with a good support system, and they bring that person to appointments,” Dr. Neumeister says.
If you don’t bring someone with you, he says you often leave the appointment and forget most of what the doctor said. You may miss things or forget about certain risks or questions you had.
If that happens, he says you should always feel free to come back for another consultation.
5. Be Prepared for Downtime
Finally, Dr. Neumeister says to prepare for some downtime. “Healing takes some time, and there’s often bruising and swelling,” he says.
If you’re in the public eye and are concerned about your appearance, you need to make sure you have some time to recover.
Cosmetic plastic surgery isn’t permanent. In general, Dr. Neumeister says people who come to him over age 65 are extremely reasonable.
“They know they’re getting older and have wrinkles. They don’t want to look abnormal, but they do want to look 10-15 years younger,” he says.
Just remember: a cosmetic procedure may take you back a decade, but it doesn’t stop the aging process.
“Aging continues,” Dr. Neumeister says.
Dr. Michael Neumeister, MD, is a Professor and Chairman of the Institute of Plastic Surgery at the Southern Illinois University School of Medicine, Springfield, IL. Dr. Neumeister's research interests and areas of expertise include tissue engineering, hand surgery, microsurgery, breast reconstruction, cleft lip and palate, hyperbaric oxygen therapy, burn care, and reconstruction. You can learn more about Dr. Neumeister on SIU Medicine’s website.
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