Does Medicare Cover Eyelid Surgery?
If you require eyelid surgery to address a troublesome health condition, Medicare may help cover the cost. Some limits and requirements may apply.
No, Medicare does not typically cover cosmetic surgery such as eyelid surgery, but you may be in luck if the procedure is considered medically necessary by a doctor.
If vision is not impaired, the surgery is considered cosmetic and does not meet Medicare's criteria for coverage. Medicare will only cover your surgery if you have:
- Physical signs of upper eyelid skin excess
- Proof of a minimum of 12 degrees (or 30 percent) of visual field obstruction as demonstrated on a visual field test (performed by an ophthalmologist)
- Documentation (preoperative photographs) of a visual problem as described by the patient
- A reviewing physician's recommendation
What Is Blepharoptosis?
As we age, changes occur in various parts of our eyes. Droopy eyelids (medically referred to as ptosis or blepharoptosis) can cause vision complications and may even signify a more serious medical problem. Eyelid surgery (or blepharoplasty) can be performed on the upper or lower lids to correct functional issues.
Is Blepharoptosis Covered by Medicare Supplement?
Medicare Supplement plans will also not cover this procedure. When eyelid surgery is performed solely for cosmetic reasons, Original Medicare benefits do not apply. Consequently, the patient will bear the costs of procedures like hooded eye surgery and other cosmetic treatments.
However, Eyelid surgery might qualify for coverage under certain conditions through Original Medicare (Medicare Part A and Part B) and Medicare Advantage (Medicare Part C) plans, provided it's medically necessary.
How Much Does a Hooded Eye Surgery Cost with Medicare?
Even if Medicare covers your eyelid surgery, you may still be responsible for paying certain out-of-pocket costs, such as deductibles, copayments and coinsurance. Medicare Part B requires an annual deductible of $240 in 2024 followed by a 20% coinsurance of the remaining Medicare-approved cost.