Does Medicare pay for blepharoplasty? The Truth About Blepharoplasty Coverage

Does Medicare pay for blepharoplasty?

Explore the essential details you need to know before deciding on eyelid surgery.

Learn about the reconstructive and functional aspects of blepharoplasty, eligibility criteria, and factors influencing coverage under Medicare Part B or Medicare Advantage.

Get insights into costs, considerations, and the criteria Medicare evaluates for approving coverage.

Make an informed decision about blepharoplasty with this comprehensive guide for Medicare recipients.

Are sagging eyelids affecting your vision?

If so, your doctor may have discussed the option of blepharoplasty to address the issue caused by the drooping skin.

Does Medicare pay for blepharoplasty?
Does Medicare pay for blepharoplasty? Photo(Free Pik)

Blepharoplasty ranks among the top five plastic surgical procedures in the United States for all people.

And its popularity continues to grow each year.

While many individuals opt for eyelid surgery for cosmetic reasons, it is more frequently performed for reconstructive or functional purposes.

Medicare benefits may cover blepharoplasty if the procedure aims to eliminate excess skin causing health or vision problems.

Before deciding on blepharoplasty, here’s essential information to consider.

What Is Blepharoplasty?

An infographic on Medicare Coverage for Blepharoplasty
An infographic on Medicare Coverage for Blepharoplasty

Blepharoplasty, commonly known as eyelid surgery, is a surgical procedure to remove excess skin, and sometimes muscle and fat, from drooping eyelids.

It can be performed on both upper and lower eyelids.

Aging causes eyelids to sag as the skin stretches, and supporting muscles lose their tone.

Severe sagging can impede vision and affect the eye’s ability to open or close properly.

Typically conducted on an outpatient basis, the procedure may involve local or general anesthesia based on your situation and your surgeon’s recommendations.

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Complete recovery from blepharoplasty usually takes several weeks, with stitches removed within 2-7 days.

Redness and swelling are common post-surgery, requiring patients to allow their eyes ample rest during the recovery period.

Health care providers advise against bending or heavy lifting for a few weeks after the procedure.

Who Should Consider Reconstructive Blepharoplasty?

Your healthcare provider might recommend eyelid surgery for reconstructive reasons if you experience:

  • Impaired vision due to sagging skin affecting daily tasks like driving.
  • Irritation or rubbing caused by excess skin on the eyelids.
  • Eyelid complications related to thyroid disease or another medical condition.
  • Muscle strain resulting from lifting sagging skin around the eyes.
  • Previous injury leading to an eyelid defect.

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Does Medicare pay for blepharoplasty? 

If blepharoplasty is medically necessary to improve function or ability, it is considered reconstructive surgery.

Original Medicare Part B or Medicare Advantage (Part C) may cover this outpatient procedure.

However, if the surgery is purely for cosmetic purposes, Medicare does not provide coverage.

Under Original Medicare Part B, you are responsible for an annual deductible of $185 (in 2019) and coinsurance payments.

For Medicare Advantage, benefits and costs depend on your specific insurance plan, so carefully review your policy details.

Estimating the final cost for blepharoplasty is challenging, and factors to consider include:

  • Doctor, hospital, or facility costs for surgery and after-care.
  • Type of outpatient facility.
  • Inpatient or outpatient procedure.
  • Coverage types.

Before approving coverage, Medicare assesses factors such as the visible excess skin on the upper eyelid;

Proof of at least 30 percent or 12 degrees of visual field obstruction, pre-surgery photographic evidence;

Documentation of a visual problem, and a physician’s recommendation based on your case.

In the United States, the average cost of blepharoplasty is slightly over $3000, but prices vary based on location, surgeon experience, and the specific procedure.

Additional costs may include facility or hospital fees, anesthesia fees, pre-procedure medical testing, and prescribed medications.

Medicare recipients can potentially receive coverage for blepharoplasty if they meet eligibility criteria.

Before proceeding, thoroughly discuss details with your physician and policy provider to make an informed decision.

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