medically necessary Archives

Are Plastic Surgeries Covered by Medicare?

When you think of plastic surgery, the Kardashians or a Real Housewife of some random city probably come to mind, but what they’ve actually had is cosmetic surgery. There is a difference between the 2 and if you have Medicare, the good news is one of them may be covered.

Plastic Surgery vs. Cosmetic Surgery

bare back — Medicare will cover breast reconstruction after breast cancer surgery.

Plastic surgery is a procedure performed because it’s medically necessary. That means you need it for medical reasons to improve the health or function of your body. Plastic surgery is sometimes referred to as reconstructive surgery. You may need plastic surgery for medical reasons after an accident, infection, tumor, malformation of a body party or other disease, such as breast cancer. Some examples of medically necessary plastic surgery covered by Medicare include treatment for severe burns, facial reconstruction following a car accident, or a breast reconstruction after a partial or full mastectomy. Cosmetic surgery is a type of plastic surgery used to enhance the natural features of the body. Surgeons generally perform cosmetic surgery to reshape normal structures of the body to improve your appearance or enhance your self-esteem. These are generally not covered by Medicare. If you’re looking to get a breast lift, facelift, neck lift, or chemical peels covered, you’re out of luck because those are considered cosmetic and are not medically necessary.

Cosmetic Surgery for Medical Reasons

Medicare may pay for a cosmetic surgery if you need it for medical reasons but you must obtain prior authorization. This means your doctor must send a prior authorization request to Medicare for approval before performing the procedure. If Medicare approves the request, you’ll pay your Medicare Part A and/or B deductible and coinsurance costs, depending on the setting of your plastic surgery, such as inpatient or outpatient. Some examples of cosmetic surgeries that may be considered medically necessary are botox to treat muscle disorders or a nose job to correct structural nose defects that affect your breathing. An eyelid surgery to remove excess tissue around your eye that may be impairing your peripheral vision would probably qualify as medically necessary as well. Only your doctor can determine whether your procedure is medically necessary so be sure to have a thorough conversation with them before going through with a procedure.

Find a Medicare Supplement Plan

eye surgery — Medicare Supplement Plans may help cover costs of certain types of plastic surgeries.

There are many reasons why you might need or want plastic surgery. Luckily Medicare Parts A and B may cover plastic surgery if you need it for medical reasons. If your plastic surgery is covered by Medicare, you may be able to find a Medicare Supplement Insurance plan that helps pay for some of your Medicare copays, deductibles and more and EZ can help. Our agents work with the top-rated insurance companies in the nation, which makes comparing plans easy, quick, and free. To get free instant quotes on plans that cover your doctors, simply enter your zip code in the bar above, or to speak to a local licensed agent, call 888-753-7207.

Does Medicare Cover Adjustable Beds?

When dealing with an illness or disability that leads to the assistance of durable medical equipment such as an adjustable bed. Questions come up, mainly how much they are, and if the costs of these beds are covered by Medicare Insurance.

black and white picture of a hospital bed — *Adjustable beds will be covered under Medicare if they are deemed medically necessary.*

Doctors can prescribe these beds for many conditions, such as sleep disorders, respiratory problems, restless leg syndrome, and more. If you do require an adjustable bed, then it must be deemed “medically necessary” by your doctor in order to be covered. Will it be completely covered? Well, it depends.

What Is Durable Medical Equipment (DME)?

Durable medical equipment is medical equipment that is reusable, such as crutches, wheelchairs, and adjustable beds. In order for a DME to be covered, it has to be used for medical reasons, durable, andused at home.

If you are staying in a nursing home, that does not qualify as your home. Therefore, it will not be covered. However, a long term care facility can give you DME, because they are responsible for your health.

Is it Medically Necessary?

Even though your doctor might determine that there is a medical purpose for DME, it does not mean it will be approved by Medicare. Once the doctor recommends it, it must be considered and reviewed by Medicare before it will pay. Not all DME is created equal. In other words, there might be a specific type of bed that is approved, while others are not.

Adjustable beds are usually prescribed to patients to help cure, relieve, and minimize circulatory and respiratory health issues. These beds help people get in and out of bed with more comfort and ease.

"20%" written in silver and enlarged — *Medicare Part B will cover 80% of the adjustable bed expense, leaving you to pay the rest (20%).*

Will Medicare Cover Adjustable Beds?

Under Medicare Part B, in the DME section, it states that they might cover adjustable beds. But there are some requirements that a person must meet first before qualifying. First, a doctor must prescribe the bed for use at home. Afterwards, the bed must be sourced by an accredited Medicare supplier. Then, Medicare Part B will cover 80% of the expense, leaving you to pay the rest (20%).

Thankfully, if you are in need of an adjustable bed in your home due to chronic pain, or certain conditions, Medicare will cover it. As long as the bed is prescribed as medically necessary, and acquired from an accredited supplier, then you will be good to go. Make sure you contact Medicare to make sure the bed is accredited before purchasing it, because some bed suppliers will mislead patients into buying unaccredited beds.