Does Medicare Cover Plastic Surgery?

Choosing the route of plastic surgery seem to be a commonplace for many people today. Such could be due to the fact that speed and accuracy are considered important conduits to achieving success whether you are going under the knife because of a medical condition or for cosmetic enhancement. Costs for such procedures could be relatively high and many patients would want to know –  does medicare cover plastic surgery?

What is Medicare?

Original Medicare or just “Medicare” pertains to a federal program designed for seniors who have reached the age of 65. This also includes people with ESRD, and the disabled or those who are under 65 but receive Social Security Disability Insurance (SSDI). You are said to be eligible for Medicare within seven months prior to your 65th birthday. Specifically, this initial enrollment period comprise of the first three months before your 65th birthday and then counting three months after that.

Medicare is under The Centers for Medicare & Medicaid Services (CMS). This is funded primarily by the Medicare taxes you pay, Social Security, Medicare premiums, and the federal budget. Now, it’s not just the elderly that could take advantage of Medicare – younger individuals can benefit from this too. This is also offered to patients who are 65 under and suffering from End-Stage Renal Disease (ESRD) which oftentimes requires either a transplant or dialysis and also to younger disabled patients. This is also very convenient as apart from the initial enrollment, you can freely change your healthcare plans following the two annual enrollment periods.

Original Medicare comprise of Hospital Insurance (Medicare Part A) and Medical Insurance (Medicare Part B). More so, there are Supplemental Medicare options that will allow you to fill the gaps when it comes to your Medicare coverage. You can choose from options such as Medicare Prescription Drug Coverage (Medicare Part D), Medigap, and Medicare Advantage (Medicare Part C) which are sold by different private companies and insurance companies as approved and authorized by Medicare. If in case you need to make anbrupt changes to your plans, it is wise to note that enrollment in any plan outsie of your initial enrollment would also entail higher premiums.

Medicare Coverage – What It Doesn’t Cover

Generally, Medicare doesn’t have coverage for certain services, supplies, and drugs which are not considered medically reasonable or even necessary. This means that such services and supplies should not be procured mainly for the convenience of either the provider or beneficiary.

Medicare doesn’t cover plastic surgery or cosmetic surgery unless of course it is deemed necessary or required medically to improve functionality in case of any deformity or as a measure to aid any types of injury. Also, if you have had mastectomy due to breast cancer, Medicare will also cover expenses for breast prostheses.
More so, if you happen to travel outside United States or the 50 states, your hospitalization would not be covered by Medicare. There is however an exception, that is if you have a medical emergency and the foreign hospital happens to be nearer than the U.S. hospital.

In any case, it is always recommended to seek clarification or advice from your medical practitioner or doctor to be sure that a particular service or item can be covered by Medicare.

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