Does Medicare Cover Facial Feminization Surgery? 

Your face is often the first thing people notice about you when meeting you in person. Although things like skincare products and makeup can change the appearance of the face, the structure and feature placement generally can’t be changed through natural means.

Once someone goes through puberty, the way the face is laid out and proportioned tends to remain static through their younger years. As men and women age, certain facial features can begin to change as skin loses elasticity, but structural features of the face remain largely unchanged.

In order to actually change your facial structure, cosmetic surgery is usually the only answer. Although people often think that cosmetic surgery is reserved for younger individuals, seniors also seek out cosmetic facial surgery. Whether you’re looking to reduce sagging skin or you want to reshape your face entirely, cosmetic procedures like facial feminization surgery may be able to help.

What is facial feminization surgery?

Facial feminization surgery is a series of cosmetic surgery procedures that are designed to reduce masculine facial features. This is done by making changes to the hairline, shaping the cheekbones and lips and changing the shape and size of the jaw and chin. Both men and women seek out facial feminization surgery.

Does Medicare cover facial feminization surgery?

Seniors who are interested in facial feminization surgery will undoubtedly want to know if Medicare covers these procedures. Unfortunately, Medicare benefits cannot be applied toward any type of elective cosmetic surgery. Medicare recipients seeking facial feminization surgery will need to cover the full cost of any procedures.

Medicare insurance is designed to help pay for medically necessary healthcare. Medicare coverage is not available for elective cosmetic surgery since the Centers for Medicare & Medicaid Services (CMS) does not consider cosmetic surgery a medical necessity.

Medicare does cover some cosmetic surgery

Although Medicare coverage is not available for facial feminization surgery, Medicare recipients can obtain coverage for some cosmetic surgery procedures. Medicare benefits cover cosmetic surgery when it is used to restore function to a part of the body that has been affected by illness or injury. For example, in the case of Medicare recipients who have undergone breast cancer treatment in the form of a mastectomy, Medicare benefits will pay for reconstructive surgery.

If a cosmetic benefit is gained from a particular surgical procedure, Medicare will cover the surgery as long as the primary reason for the procedure is not solely cosmetic. This means that Medicare insurance will not pay for a surgical procedure because you are unhappy with a part of your body. Medicare will, however, pay for a cosmetic surgery procedure if it’s a side effect of a medical necessary procedure. 

How does Medicare pay for cosmetic surgery?

Outpatient surgical procedures of all kinds are usually covered by Medicare Part B. Medicare recipients pay 20% of the cost of outpatient medical care under Part B. If cosmetic surgery is provided as part of an inpatient treatment plan while hospitalized, Medicare Part A may apply instead. This is the inpatient benefit of Medicare insurance, and all inpatient care is covered for a limited number of days each benefit period.

Do Medicare Advantage plans cover facial feminization surgery?

Medicare Advantage plans may offer some additional benefits beyond what Original Medicare provides. Medicare Advantage plans have more flexibility regarding their offerings, but they typically do not cover elective cosmetic surgeries like facial feminization surgery. To discuss whether your Medicare Advantage plan covers any additional types of surgery, you will need to speak with your plan provider.

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