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.
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
Understanding Eyelid Surgery
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.
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 $226 in 2023 followed by a 20% coinsurance of the remaining Medicare-approved cost.