Will Medicare cover my Plastic Surgery?

Have you been thinking about getting plastic surgery but are not sure about procedures and what is affordable on our Australian Medicare system? When it comes to plastic surgery, the Medicare MBS guidelines are very clear. Medicare will not cover ‘non-therapeutic cosmetic surgery’. This means Medicare will not cover elective surgeries that you choose to pursue purely cosmetic reasons – it will only cover procedures that are clinically necessary for your health or medically necessary that meet strict criteria.

What is a valid medical reason for having plastic surgery?

A valid medical reason for surgery can include things like:

Plastic surgery following skin cancer removal
Facial reconstructive surgery after an accident or trauma
Rhinoplasty to rectify an obstructed nasal passage
Breast reconstruction following a mastectomy or removal/replacement of implant
Surgery following massive weight loss (removal of loose skin, abdominoplasty and such)

With other procedures, the best way to find out if your own individual circumstances will be covered is to consult with a medical professional to determine if you will be covered.

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Will medicare cover…

Who decides if I meet the Medicare criteria?

If you are embarking upon plastic surgery for a recognised medical purpose, the first step is to obtain a referral letter from your family GP to go and see a specialist. In order to be covered by Medicare, you need to ensure that the specialist you’re referred a RACS Surgeon, preferably an accredited plastic surgeon with the Australian Society of Plastic Surgeons

Plastic Surgeons and “Cosmetic Surgeons” are NOT the same! Even though they sound similar they are different- and this makes a big difference when it comes to Medicare. Medicare and your Health Fund will only cover you if you approach a fully-trained and qualified accredited surgeon, not just a cosmetic doctor.

Is my procedure covered by Medicare?

The Medicare Benefits Schedule (MBS) is searchable online and is a great resource if you’re doing some preliminary research about your chosen procedure.

Here is an overview of some of the main types of plastic surgeries that are listed on the MBS:

Will Medicare cover my Tummy Surgery?

If you meet the strict criteria, Medicare will cover an Abdominoplasty or Tummy Tuck – find out more in this blog.

Will Medicare cover my Breast Surgery?

Breast reduction mammoplasty (with or without the relocation of the nipple). If you are a woman with fuller breasts and you are looking for a reduction because you’ve been experiencing health issues, you will be covered by Medicare.

Breast augmentation (mammoplasty) is also on the MBS, but only under VERY LIMITED conditions:

Where breast asymmetry exists;
Following mastectomy; or
Where there is a malformation of breast tissue, disease or trauma to the breast (excluding trauma from prior elective cosmetic surgery)

Breast reconstruction following mastectomy or trauma is on the list, but that again excludes any trauma caused by previous elective cosmetic surgery. You may also be eligible for cover on Removal and/or replacement of breast prosthesis and reconstruction of the nipple or areola (or both) if there is a medical reason for the surgery.

Will Medicare Cover my Breast Lift?

Here are the criteria for MBS coverage of a Breast Lift Surgery

Will Medicare Cover My Breast Implant Surgery?

Here are the criteria for MBS coverage of Breast Implant Surgery

Will Medicare Cover My Nose Surgery or Rhinoplasty?

Rhinoplasty is on the MBS, but there are strict criteria under what circumstances it is covered. The actual MBS goes into very specific detail about this. But if you require rhinoplasty to correct nasal obstructions or post-traumatic deformities (other than those resulting from cosmetic surgery), then you may be covered.

Will Medicare Cover My Ear Reconstruction surgery?

Ear Reconstructions are a less common procedure, reconstructive surgery of the ear is covered by Medicare to correct ‘lop ear’ or ‘bat ear’ or, other similar deformities.

Will Medicare cover Facial Plastic surgeries?

Meloplasty (a form of facial surgery that tightens and removes skin on the face and neck) can be found on the MBS. Cover will extend in situations;

Where a patient has facial asymmetry due to a soft tissue abnormality
Meloplasty due to;
- congenital conditions
- disease
- Or, trauma. However, this excludes trauma caused by previous elective cosmetic surgeries.

Surgeries such as Facelifts, brow lifts and chin lifts are EXCLUDED. This is due to the fact that they are seen as purely elective cosmetic procedures.

Will Medicare cover Plastic Surgery After Weight Loss?

Plastic surgery is very common after significant weight loss and is generally covered by Medicare. This is because there are valid medical reasons as to why the surgery is necessary.

Excess skin can not only interfere with regular activities and day-to-day living but it can also cause skin irritation, rashes and sores. Surgery relating to the removal of redundant abdominal skin and fat as a direct result of large-scale weight loss is usually on the MBS.

This can also include radical abdominoplasty and other related procedures. However, in order for you to be eligible for cover, your weight must have been stable, for at least six months prior to surgery.

Other related procedures on Medicare MBS

Some of the other procedures on the MBS include:

Full face chemical peel for severely sun-damaged skin or severe chloasma or melisma (also often termed the ‘mark of pregnancy’)
Abrasive therapy for severely disfiguring scarring resulting from trauma, burns or acne
Carbon dioxide laser or erbium laser resurfacing of the face or neck for severely disfiguring scarring resulting from burns, trauma or acne
Gastric band surgery, where clinical morbid obesity has been diagnosed
Cleft lip and cleft palate surgery

You should always check the most up to date information via Medicare or contact our team at Coco Ruby Plastic Surgery on 1300 264 811 to discuss estimated out of pocket expenses for your specific surgery. Our team can also give you information about our payment methods, which make plastic surgery even more accessible, with or without Medicare coverage.