Health insurance doesn’t usually cover plastic surgery, but exceptions can be made when the surgery is medically necessary, such as reconstructive surgery to correct congenital anomalies or cosmetic differences resulting from illness or injury. Health insurance rarely pays for procedures meant only to physically change an area of the body for aesthetic reasons.

Here’s what you need to know about health insurance coverage for plastic surgery.

Learn More: Do I Need Health Insurance Coverage?

Does health insurance pay for cosmetic surgery?

Health insurance providers don’t cover procedures that aren’t medically necessary. Most insurers don’t consider elective cosmetic surgery medically necessary, so it’s something standard health insurance doesn’t cover. Procedures done purely for cosmetic reasons aren’t essential for your physical health.

Even when insurance covers medically necessary plastic surgery, some policies may not cover it in full. Insurers might cover only a portion of the procedure or pre-surgical testing. And you’ll still be responsible for any co-insurance, copays, or deductibles.

When might health insurance cover plastic surgery?

Health insurance coverage might include reconstructive surgery or other plastic surgery procedures that are medically necessary. Your HMO or PPO plan or another health insurance policy might cover procedures that will improve your overall health, such as weight loss surgery for people whose extra weight amplifies medical conditions.

An insurance company might pay if your plastic surgery is for:

• Facial reconstruction after having a tumor removed

• Breast reconstruction after a mastectomy

• Cleft lip and palate repair

• Flap reconstruction after skin cancer removal

• Breast reduction when the extra weight causes back pain

• Tummy tuck when excess skin or weight impacts mobility

Sometimes, it’s not entirely clear whether a procedure is cosmetic or reconstructive. The American Society of Plastic Surgeons (ASPS) has guidelines concerning some of these procedures. If you’re considering plastic surgery, reviewing these guidelines can help you determine if your procedure falls in the reconstructive category.^[1]

For example, rhinoplasty performed for cosmetic reasons isn’t reconstructive. But a nose job to correct deformities that cause breathing problems is medically necessary.^[2]

Keep Reading: What to Do if Your Health Insurance Claim Is Denied

What is reconstructive surgery and does insurance pay for it?

Reconstructive surgery corrects cosmetic deformities caused by illness or injury or created during fetal development. Cosmetic procedures performed to address these deformities or abnormalities are generally medically necessary.

Examples of reconstructive surgery procedures that your health insurance might pay for include breast augmentation to achieve symmetry (even when not a result of cancer treatment), fixing a cleft palate, correcting a deviated septum, and the removal of skin lesions.

Elective cosmetic surgery that people choose to undergo for the sole purpose of changing their physical appearance isn’t considered medically necessary. These procedures include face lifts, breast augmentations, and liposuction.

How to check if your insurance will cover a plastic surgery procedure

Knowing whether your insurance covers cosmetic surgeries allows you to understand the extent of any coverage and plan for out-of-pocket expenses. It also helps you choose a surgeon or clinic that accepts your insurance and fits your budget. Here’s how to check if your insurance plan will cover a plastic surgery procedure:

1. Read your health insurance plan summary of benefits and coverage. This is the best way to check if your insurance will cover your plastic surgery procedure. You should have received a plan summary when you enrolled in your health plan, but if you don’t have it, ask your insurance company for a copy.

2. Call your doctor’s office. The office where you choose to have the surgery can also help you determine if the surgery will be covered and what your out-of-pocket costs might be. Your insurance company may require pre-authorization for certain tests and procedures, so you’ll have a better understanding ahead of time of what your insurance will and won’t pay for.

Your doctor’s recommendation can go a long way toward getting your insurance company to cover your procedure. Your chances of coverage are greater when your doctor recommends the surgery for medical reasons rather than for cosmetic ones. Keeping records of your symptoms and doctor visits can also help prove the medical necessity of a procedure to your insurance company.

Learn More: How Are Health Insurance Premiums Calculated?

What are the costs associated with plastic surgery?

Here are average costs of some common plastic surgery procedures, according to The American Society for Aesthetic Plastic Surgery:^[4] 

• Breast implants: $4,866

• Breast lift: $4,616

• Breast reduction: $5,717

• Brow lift: $4,021

• Face lift: $9,025

• Tummy tuck: $6,622

• Liposuction: $2,584

• Hair transplant: $7,210

Costs will vary depending on where you live, and your surgeon, and may not include all expenses. You may also have to pay a copay.

Plastic surgery and insurance coverage FAQs