The decision to have cosmetic surgery is a big one. Costhetics has written often in this space about the importance of doing your homework before you go under the knife.

Generally we focus on subjects such as ways to find the best surgeon, realistic expectations, the difference between various surgical procedures and techniques, and what to expect from start to finish.

However, there’s another very important subject you need to research thoroughly: Medicare coverage.

#1 Question for Anyone Considering Cosmetic Surgery

In the past, we’ve explored what to expect with regard to average prices for many surgeries, but until today, we haven’t answered the #1 question that’s on every patient’s mind: “Will my procedure be covered by Medicare?” It’s a great question, but one that may not be as easy to answer as you might imagine.

Like so many things related to cosmetic surgery, there is no one-size-fits-all answer. There are many variables to consider, and that’s what we’re doing in today’s article.

The Difference between Cosmetic Surgery and Plastic Surgery

Cosmetic surgery and plastic surgery are related, but they are not the same. Think of them as kissing cousins. What’s the difference? That’s another good question!

  • Cosmetic Surgery – This surgery is performed on uninjured body parts merely to improve their aesthetic appearance. It is considered an elective procedure.
  • Plastic Surgery – This surgery is also known as reconstructive surgery. It involves correcting physical abnormalities a patient may have due to genetics, a health condition, or trauma. It is considered a medical necessity.

Some surgeries offer both medical and aesthetic benefits. For example, a person who undergoes rhinoplasty to improve breathing (plastic surgery) may also request that their nose be reshaped (cosmetic surgery) to be harmonious with the rest of their face. When a woman has a mastectomy, breast implant surgery is considered medical, not just cosmetic.

The Difference between a Cosmetic Surgeon & a Plastic Surgeon

As a patient, you should also be aware that different training is required for plastic and cosmetic surgeons. All doctors are awarded a MBBS (Medical Bachelor/Bachelor of Surgery) degree when they complete their training, and all are qualified to perform cosmetic surgery, regardless of their medical specialty.

To be considered a plastic surgeon, a doctor must complete an additional eight years of training. This training includes a fellowship from The Royal Australian College of Surgery.

Will MY Surgery Be Covered by Medicare?

As a rule of thumb, you should not expect reimbursement from Medicare for a purely cosmetic procedure. Medicare is intended for procedures related to health and wellbeing, not to looking good. Be aware, however, that your doctor may apply for an exception on your behalf. Information such as the reason for the surgery, clinical details, and photos may all be required.

You can download a complete listing of the September 2017 Benefits Schedule from the Department of Health website. If you find your procedure listed there, chances are you’re covered. Team Costhetics knows you’re a busy bee who may not have time to sift through the entire document. (You could be watching Game of Thrones!) That’s why we’ve cherry-picked the document so you can know what’s-the-what when it comes to three of Australia’s most popular surgical procedures.

Does Medicare Pay for Breast Augmentation?

Breast enhancement surgery (mammoplasty) is only covered when it is being performed to correct:

  • Effects of mastectomy – including restoration of nipples and areola, as well as breast implant.
  • Breast asymmetry – one breast must be at least 10% larger than the other.
  • Drooping/sagging breasts – for women who are experiencing breast ptosis as the result of pregnancy and lactation (This surgery is not covered more than 7 years after pregnancy).
  • Malformed breast tissue.
  • Breast disease or trauma (this does not include revision surgery after a previous augmentation).

Breast reduction is generally considered an elective cosmetic procedure. However, a surgeon can apply for an exception for women whose large breasts are impacting their posture and comfort.

Does Medicare Cover Abdominoplasty?

Abdominoplasty (tummy tuck) is a procedure that removes excess skin and fat from the abdominal area of the body. The surgeon also tightens the muscle and fascia of the abdominal wall to give patients a trimmer, flatter midsection.

It is very rare that a tummy tuck is covered by Medicare. One exception is for patients who have lost a tremendous amount of weight. The excess hanging skin that remains can affect movement and quality of life. When this is the case, a surgeon may apply for an exception.

Does Medicare Pay for Rhinoplasty?

Rhinoplasty is one of the most often requested surgical procedures in Australia. Nose jobs for beauty are not covered, but rhinoplasty for better breathing is. Rhinoplasty is covered when it:

  • Corrects the bony and cartilaginous elements of the nose (external).
  • Corrects an obstruction in the nasal passages.
  • Corrects a deformity caused by trauma (this does not include revision rhinoplasty to “re-do” a previous elective cosmetic surgery).
  • Corrects a significant genetic nasal deformity (such as a cleft palate).

If this information has left you reeling a bit, you’re not alone. Many people have trouble sorting out the details of our wonderful—though occasionally complex—Medicare system. As always, Team Costhetics says, “Talk to your doctor.” Doctors and their staff are well versed in the ins and outs of Medicare benefits and can give you the guidance you need.

Stay beautiful!

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