Dropping weight can have a downside; such as rashes or infections from extra skin. If you suffer from excess skin after weight loss, Medicare covers skin removal. Excess skin removal may not be the stage of weight loss you foresaw; however, insurance can help pay for the service.
Coverage for plastic surgery for treatment or repair is likely. This can include repair after an accident or for the treatment of severe burns. Some therapeutic surgeries that serve a cosmetic change may be allowable.
Let's say Sally has breast implants that prevent breast cancer treatment. Well, Part A can help with costs in an inpatient setting. If the procedure is done in an outpatient setting, Part B covers 80% of the costs. For the lowest cost, go to a doctor that takes Medicare.
Medicare Part B offers comprehensive coverage for outpatient services, durable medical equipment, and doctor visits. There are two main types of coverage under Medicare Part B: medically necessary services and preventative services.
Medically necessary Medicare Part B coverage encompasses a variety of tests, procedures, and care options. To be considered medically necessary, the medical service or supply must be required to treat or diagnose a medical condition. Each situation is different, so a medical supply or service that is deemed medically necessary for one person may not be medically necessary for another.
Most insurance companies do not pay for cosmetic surgery and Medicare is no exception. Of course, it gets more complicated when a procedure that is considered cosmetic is performed for medical reasons.
Medicare classifies surgical procedures as inpatient or outpatient. The Centers for Medicare & Medicaid Services (CMS) releases a list of inpatient only (IPO) procedures every year. These procedures are more surgically complex, at higher risk for complications, and require close post-operative monitoring. They are covered by Medicare Part A.
Any procedure that is not on the IPO list is an outpatient procedure and is billed to Medicare Part B. An outpatient procedure could be considered for an inpatient hospital stay if the patient has underlying medical conditions that increase their risk for complications, has surgical complications, or has post-operative problems.
Reconstructive plastic surgery is used to repair areas of the body that may be affected by trauma, disease, or developmental defects. Cosmetic plastic surgery is a type of plastic surgery that is used to enhance the natural features of the body. Medicare will cover what is deemed essential reconstructive surgery and procedures that have associated Medicare item numbers listed in the Medicare Benefits Schedule (MBS).
Insurance helps pay for the cost of breast reconstruction surgery after mastectomy or lumpectomy. This can be done right away or years later.
Medicare will never cover an elective surgery; however, when a doctor deems it a necessity, they will pay a part. If you believe your breast reconstruction surgery should have coverage and medicare denies, you can file an appeal.
You may also pay the hospital a copayment for each service you get in an outpatient setting. For both inpatient and outpatient procedures, the surgery must be performed by a health care provider who accepts Medicare. These outpatient procedures are done in an outpatient clinic, and you can return home the same day as the surgery. However, most medically necessary plastic surgery procedures are inpatient procedures.