Health insurance doesn’t usually cover plastic surgery, but exceptions can be made when the surgery is medically necessary, such as reconstructive surgery to correct congenital anomalies or cosmetic differences resulting from illness or injury. Health insurance rarely pays for procedures meant only to physically change an area of the body for aesthetic reasons.
Here’s what you need to know about health insurance coverage for plastic surgery.
Learn More: Do I Need Health Insurance Coverage?
Table of contents
- Does health insurance pay for cosmetic surgery?
- When might health insurance cover plastic surgery?
- What is reconstructive surgery and does insurance pay for it?
- How to check if your insurance will cover a plastic surgery procedure
- What are the costs associated with plastic surgery?
- Plastic surgery and insurance coverage FAQs
Does health insurance pay for cosmetic surgery?
Health insurance providers don’t cover procedures that aren’t medically necessary. Most insurers don’t consider elective cosmetic surgery medically necessary, so it’s something standard health insurance doesn’t cover. Procedures done purely for cosmetic reasons aren’t essential for your physical health.
Even when insurance covers medically necessary plastic surgery, some policies may not cover it in full. Insurers might cover only a portion of the procedure or pre-surgical testing. And you’ll still be responsible for any co-insurance, copays, or deductibles.
When might health insurance cover plastic surgery?
Health insurance coverage might include reconstructive surgery or other plastic surgery procedures that are medically necessary. Your HMO or PPO plan or another health insurance policy might cover procedures that will improve your overall health, such as weight loss surgery for people whose extra weight amplifies medical conditions.
An insurance company might pay if your plastic surgery is for:
Facial reconstruction after having a tumor removed
Breast reconstruction after a mastectomy
Cleft lip and palate repair
Flap reconstruction after skin cancer removal
Breast reduction when the extra weight causes back pain
Tummy tuck when excess skin or weight impacts mobility
Sometimes, it’s not entirely clear whether a procedure is cosmetic or reconstructive. The American Society of Plastic Surgeons (ASPS) has guidelines concerning some of these procedures. If you’re considering plastic surgery, reviewing these guidelines can help you determine if your procedure falls in the reconstructive category.
For example, rhinoplasty performed for cosmetic reasons isn’t reconstructive. But a nose job to correct deformities that cause breathing problems is medically necessary.
Keep Reading: What to Do if Your Health Insurance Claim Is Denied
What is reconstructive surgery and does insurance pay for it?
Reconstructive surgery corrects cosmetic deformities caused by illness or injury or created during fetal development. Cosmetic procedures performed to address these deformities or abnormalities are generally medically necessary.
Examples of reconstructive surgery procedures that your health insurance might pay for include breast augmentation to achieve symmetry (even when not a result of cancer treatment), fixing a cleft palate, correcting a deviated septum, and the removal of skin lesions.
Elective cosmetic surgery that people choose to undergo for the sole purpose of changing their physical appearance isn’t considered medically necessary. These procedures include face lifts, breast augmentations, and liposuction.
Even if your insurance will cover a reconstructive procedure, you’ll still be responsible for paying your deductible and maximum out-of-pocket amount before your insurance plan will cover the remaining amount.
If you have a health savings account (HSA), you may be able to use the funds to cover some of your out-of-pocket expenses.
How to check if your insurance will cover a plastic surgery procedure
Knowing whether your insurance covers cosmetic surgeries allows you to understand the extent of any coverage and plan for out-of-pocket expenses. It also helps you choose a surgeon or clinic that accepts your insurance and fits your budget. Here’s how to check if your insurance plan will cover a plastic surgery procedure:
Read your health insurance plan summary of benefits and coverage. This is the best way to check if your insurance will cover your plastic surgery procedure. You should have received a plan summary when you enrolled in your health plan, but if you don’t have it, ask your insurance company for a copy.
Call your doctor’s office. The office where you choose to have the surgery can also help you determine if the surgery will be covered and what your out-of-pocket costs might be. Your insurance company may require pre-authorization for certain tests and procedures, so you’ll have a better understanding ahead of time of what your insurance will and won’t pay for.
Your doctor’s recommendation can go a long way toward getting your insurance company to cover your procedure. Your chances of coverage are greater when your doctor recommends the surgery for medical reasons rather than for cosmetic ones. Keeping records of your symptoms and doctor visits can also help prove the medical necessity of a procedure to your insurance company.
Learn More: How Are Health Insurance Premiums Calculated?
What are the costs associated with plastic surgery?
Here are average costs of some common plastic surgery procedures, according to The American Society for Aesthetic Plastic Surgery:
Breast implants: $4,866
Breast lift: $4,616
Breast reduction: $5,717
Brow lift: $4,021
Face lift: $9,025
Tummy tuck: $6,622
Hair transplant: $7,210
Costs will vary depending on where you live, and your surgeon, and may not include all expenses. You may also have to pay a copay.
Health Savings Tip:
You may be able to save on other costs related to your plastic surgery procedure. For example, if your insurance plan comes from the ACA marketplace, your insurance premiums may be tax-deductible.
Plastic surgery and insurance coverage FAQs
Patients often have many questions about their plastic surgery procedures and whether their health insurance will cover them. Each policy differs, but here are answers to some commonly asked questions about insurance coverage for plastic surgery.
Does Medicare cover plastic surgery?
Medicare will usually only pay for plastic surgery that’s needed to reconstruct or improve function due to abnormality or injury. It might require pre-authorization for some procedures. If Medicare pre-authorizes a procedure, you can plan on paying only your deductible and co-insurance.
Do marketplace insurance plans cover plastic surgery?
Marketplace insurance plans may cover plastic surgery that’s deemed medically necessary. Hospitalizations, including surgeries, are among the 10 essential health benefits all marketplace plans must provide coverage for. Some marketplace insurance plans might also cover plastic surgery when it’s necessary for pain management. Check with your insurance company to see what is and isn’t covered under your specific plan.
Why won’t insurers cover plastic surgery?
Insurance companies typically don’t cover plastic surgery because it’s often elective rather than medically necessary. Plastic surgery performed solely to enhance a person’s appearance isn’t essential for health preservation, and insurance companies prioritize covering medical procedures that are deemed essential for a person’s health and well-being.
What should you do if your insurance won’t cover the cost of your cosmetic procedure?
You can appeal an insurer’s denial of your cosmetic surgery claim. Your insurance policy should provide instructions on how to file an appeal, or you can ask your health insurance company. Your claim might be approved if your doctor confirms your procedure’s medical necessity. If your appeal fails, you might be able to get a loan for the procedure or negotiate a payment plan with your medical provider.
What qualifies a cosmetic procedure as medically necessary?
While health plans differ, most insurers consider procedures medically necessary if they’re needed to treat or diagnose an illness or injury. If your cosmetic procedure is to change your physical appearance and not due to a defect or injury, it likely won’t qualify as medically necessary.
- American Society of Plastic Surgeons. "ASPS Recommended Insurance Coverage Criteria." Accessed February 14, 2023
- American Society of Plastic Surgeons. "Nasal Surgery." Accessed February 14, 2023
- HealthCare.gov. "Health Savings Account (HSA)." Accessed February 14, 2023
- American Society for Aesthetic Plastic Surgery. "What Are The Average Costs For Plastic Surgery Procedures?." Accessed February 16, 2023
- Internal Revenue Service. "The Premium Tax Credit - The Basics." Accessed February 14, 2023
- Medicare.gov. "Cosmetic surgery." Accessed February 14, 2023
- HealthCare.gov. "What Marketplace health insurance plans cover." Accessed February 14, 2023