Liposuction: Does Medicare Cover it?

medicare coverage, liposuction
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Liposuction is a cosmetic procedure used to break up fat deposits and reshape certain areas of the body. It is commonly used on hips, thighs, abdomen, neck, buttocks, back, or upper arms. It’s considered plastic surgery and sometimes paired with a tummy tuck or breast reduction. However, it’s not a treatment for obesity and cannot replace a healthy diet and exercise.

The average cost of liposuction in 2019 was $3,538. That cost can vary depending on where you live and which doctor you go to.

Does Medicare cover liposuction?

No, in most cases Medicare does not cover liposuction because it is deemed a cosmetic and elective surgery. In fact, no insurance company will cover elective liposuction. If you wish to have liposuction done, you will need to pay for it out of pocket.

Original Medicare will ONLY cover liposuction if it is deemed medically necessary and required to improve the function of a malformed organ or correct an accidental injury. It may also be used to treat medical conditions such as benign fatty tumors (lipomas), enlargement of male breasts, problems metabolizing fat, or excessive armpit sweating. If you feel like liposuction is medically necessary, you should contact Medicare directly to find out if you’re eligible for coverage.

One type of cosmetic surgery that Medicare does cover is breast prostheses for breast reconstruction after a mastectomy due to breast cancer. Certain other cosmetic surgeries may be deemed medically necessary and would only require prior authorization by Medicare. These may include:

  • Blepharoplasty to remove droopy eyelid tissue
  • Botox to treat muscle spasms
  • Panniculectomy to remove excess skin from the lower abdomen
  • Rhinoplasty to change the shape of your nose
  • Vein ablation to close off veins.
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What are some liposuction alternatives?

Even though Medicare (and Medicaid) doesn’t cover liposuction, they may cover other weight loss procedures like gastric bypass surgery, lap band surgery, or sleeve gastrectomy procedure.

To qualify for weight loss surgery, you must:

  • Have one or more instances of co-morbidity (a serious illness caused by obesity, like high blood pressure, diabetes, and sleep apnea)
  • Have been obese for the past five years
  • Have a BMI of 35 or higher
  • Show that you have enrolled in a medically supervised weight loss program and that you have failed at least one in the past
  • Provide Medicare with a letter from your doctor recommending weight loss surgery
  • Undergo a physical test
  • Have your doctor demonstrate that all other medical conditions (like pituitary, thyroid, and adrenal conditions) have been ruled out as potential causes of obesity.

Even though weight loss surgery sounds like a lengthy process, your chances of getting it covered by Medicare are significantly higher than getting liposuction covered.

Other ways Medicare can help with weight loss are the SilverSneakers fitness benefit, annual obesity screening, and Medicare nutrition therapy services.

If you truly feel like you need liposuction, you may be able to finance the procedure through the provider or specialist who performs it. In addition to liposuction, there are non-invasive options such as Coolsculpting and tummy tuck. Note that liposuction is not recommended for weight loss; it will not permanently get rid of cellulite or stretch marks. After liposuction, one must continue to lead a healthy lifestyle, or the fatty areas will return or appear elsewhere.

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