You wouldn’t think that Medicare would cover cosmetic surgeries like liposuction, and in most cases you would be right. Medicare doesn’t cover cosmetic surgery unless it is needed to improve the function of a malformed body part or because of accidental injury. For example, Medicare may cover breast prostheses for reconstructive surgery if the patient had breast cancer or a mastectomy.
If you are seeking liposuction as a solution to a medical condition, there is a slim chance that you may be able to get Medicare to cover the procedure. You will need a doctor to submit written paperwork detailing why liposuction is a necessary part of your treatment. If you believe that liposuction surgery is a medical necessity, contact both your doctor and Medicare directly to see if you’re eligible for coverage. You can reach Medicare by phone at 1-800-633-4227. Be aware, though, that Medicare administrations consider liposuction a purely cosmetic procedure and thus are very unlikely to offer coverage.
Possible alternatives to liposuction
If Medicare will not cover liposuction, you might consider if gastric bypass surgery meets your needs. Typically patients have a higher chance of getting this procedure covered. However, it is the responsibility of you and your doctor to prove that it is a medical necessity.
There are several stipulations that you must satisfy in order to be granted coverage for weight loss surgery. For starters, you must have one or more instances of co-morbidity. A co-morbidity is a serious illness that is caused by or otherwise related to obesity. High blood pressure, diabetes, and sleep apnea are all examples of co-morbidities. In addition to one or more co-morbidities, you must prove that you have been obese for the past five years. You must have a body mass index (sometimes abbreviated as BMI) of 35 or higher. Also, you must show that you have enrolled in one or more medically supervised weight loss programs and that you have failed at least one of these. You must provide Medicare with a letter from your doctor that recommends you for weight loss surgery. Additionally, you must undergo a thorough psychological test. Finally, your doctor must demonstrate that all other treatable medical conditions have been examined and dismissed as potential causes of your obesity condition. Typically this involves undergoing pituitary, thyroid, and adrenal screening exams.
In terms of available surgeries, currently Medicare offers coverage for duodenal switch procedures, gastric bypass surgery, lap band and realize band surgery, and sleeve gastrectomy procedures. Sleeve gastrectomy surgery coverage varies depending on where you live.
Like Medicare, Medicaid does not cover liposuction, even if you meet the program’s low income requirements. If you feel that you truly need liposuction surgery after consulting with your doctor, you can typically finance the procedure through the provider or specialist who performs the surgery.