Does Medicare cover blepharoplasty?

Looking for answers about whether Medicare covers blepharoplasty? Medicare never covers the cost of any cosmetic procedures, but there are some cases when blepharoplasty is medically necessary. If blepharoplasty is medically necessary, then Medicare will cover the costs. Read on to learn in which scenarios Medicare will and will not cover the cost of blepharoplasty surgery.

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D. Gilson is a writer and author of essays, poetry, and scholarship that explore the relationship between popular culture, literature, sexuality, and memoir. His latest book is Jesus Freak, with Will Stockton, part of Bloomsbury’s 33 1/3 Series. His other books include I Will Say This Exactly One Time and Crush. His first chapbook, Catch & Release, won the 2012 Robin Becker Prize from Seve...

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Leslie Kasperowicz holds a BA in Social Sciences from the University of Winnipeg. She spent several years as a Farmers Insurance CSR, gaining a solid understanding of insurance products including home, life, auto, and commercial and working directly with insurance customers to understand their needs. She has since used that knowledge in her more than ten years as a writer, largely in the insuranc...

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Reviewed by Leslie Kasperowicz
Farmers CSR for 4 Years

UPDATED: Jan 20, 2021

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The Highlights

  • Medicare will not cover the costs of cosmetic surgeries.
  • If, however, the blepharoplasty is considered to be medically necessary, then Medicare will cover the costs.
  • For blepharoplasty to be considered medically necessary, there needs to be a minimum of 30% total field-of-view obstruction.

Blepharoplasty is a medical procedure that removes the skin, muscle, and/or fat from the eyelids. Blepharoplasty can be performed on the top eyelid, the bottom eyelid, or both. But does Medicare cover blepharoplasty?

There are a number of reasons that one might want to get blepharoplasty, ranging from cosmetic reasons to suffering from vision obstruction.

Upper eyelids surgery, for example, is usually chosen when an individual is unhappy with having heavily hooded eyelids. Cosmetic eyelid surgery can also fix “baggy eyes”, which is when there is an excess of skin on the lower eyelid. “Baggy eyes” is actually a condition that is actually known as dermatochalasis.

If you are feeling lost while navigating health insurance provider questions and you’re considering blepharoplasty, then that is completely understandable. Sometimes health insurance can be confusing, but luckily there are numerous different health insurance resources that are available for you. We will also be answering some questions that you might have regarding blepharoplasty below.

Before you read further, we highly recommend that you take a moment to give our insurance comparison tool a try. This is a free tool, and all you need is your ZIP code to start comparing the best health insurance rates in your area.

Does Medicare or Health Insurance pay for cosmetic surgery?

Medicare will never pay for cosmetic surgery, and whether or not your health insurance will depend on the provider and the insurance plan. Most health insurance policies, however, will only pay for the procedure if it is classified as “reconstructive” and not “cosmetic” in most circumstances.

According to the Aesthetic Society, eyelid surgery is in the top 5 most common cosmetic surgeries performed in the United States. Because of this, you might want to get blepharoplasty to complement another medically necessary procedure.

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Can I combine eyelid surgery with other procedures?

You can combine various eyelid procedures with other procedures. These other procedures are often cosmetic surgeries as well, and opting to get blepharoplasty at the same time could change the overall outcome.

If the blepharoplasty procedure is deemed medically necessary, but these other procedures are not, then this can complicated things. Medicare will cover the cost of the eyelid surgery, but not the other procedures.

The inverse of this is also true. If you are getting a medically necessary procedure done and choose to get cosmetic blepharoplasty done at the same time, then Medicare will cover the cost of the other surgeries but not the blepharoplasty.

Your health insurance provider might require you to meet certain criteria when getting multiple procedures done at once, however.

Out-of-Pocket Costs

If your blepharoplasty was deemed to be medically necessary, and you did not get any additional procedures, then there should be no out-of-pocket costs. We still recommend that you always check with your actual health insurance provider. They might have specific criteria that you must meet in order to cover the costs.

On the other hand, if your blepharoplasty is purely cosmetic, then Medicare will not cover the costs. In this case, your health insurance provider might still cover some of the cost.

If you’re worried about your out-of-pocket costs, we encourage you to try out this free health insurance quote comparison tool and shop around before you buy health insurance. It will help you to make sure that not only are you getting the most affordable health insurance rates in your area, but will also help you to find a plan that works for you.

Are you looking for free insurance quotes?

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