Does Medicare Cover Plastic Surgery? Everything You Need to Know

When considering any cosmetic or reconstructive procedure, one of the most common questions people ask is: Does Medicare cover plastic surgery? The answer isn’t a simple yes or no—it depends on the type of procedure, your medical condition, and how the surgery impacts your health.

Introduction
Understanding Medicare in Australia
Cosmetic vs Reconstructive Surgery: What’s the Difference?
When Does Medicare Cover Plastic Surgery?
Common Procedures That May Be Covered
What Plastic Surgeries Are NOT Covered?
Eligibility Criteria for Coverage
How to Apply for Medicare Plastic Surgery Coverage
The Role of Private Health Insurance
Choosing the Right Plastic Surgeon
FAQs About Medicare and Plastic Surgery
Final Thoughts

1. Introduction

Plastic surgery can be life-changing—improving not just your appearance, but also your health, confidence, and comfort. However, the cost of plastic surgery can be significant, making Medicare coverage an important consideration. At BB Clinic, we believe in transparent and informed decision-making, so let’s explore how Medicare fits into the picture.

2. Understanding Medicare in Australia

Medicare is Australia’s publicly funded universal healthcare system. It provides access to a wide range of medical services for free or at a reduced cost, including hospital treatment, general practitioners, and some specialist procedures.

But when it comes to plastic surgery, Medicare makes a clear distinction between procedures that are medically necessary and those that are purely cosmetic.

3. Cosmetic vs Reconstructive Surgery: What’s the Difference?

Before diving into coverage details, it’s crucial to understand the difference between cosmetic and reconstructive plastic surgery.

Cosmetic Surgery: Performed to enhance appearance without a medical need. Examples include liposuction, breast augmentation, and facelifts.
Reconstructive Surgery: Aimed at correcting abnormalities caused by birth defects, trauma, infections, tumors, or disease. These may include procedures like breast reconstruction after a mastectomy or correcting nasal defects that affect breathing.

Only reconstructive procedures or those that serve a medical purpose are potentially covered by Medicare.

4. When Does Medicare Cover Plastic Surgery?

Medicare does cover plastic surgery when it is deemed medically necessary. That means the procedure must:

Be necessary to treat a medical condition
Improve bodily function (not just appearance)
Be recommended by a specialist

For example, if a skin removal surgery is needed after massive weight loss to prevent infections, Medicare may cover it. Similarly, reconstructive breast surgery post-mastectomy is typically covered.

The procedure must also be listed on the Medicare Benefits Schedule (MBS) and meet specific criteria.

5. Common Procedures That May Be Covered

Here are some examples of plastic and reconstructive surgeries that may be eligible for Medicare coverage in Australia:

1. Breast Reconstruction

Following mastectomy due to breast cancer.
Includes implants or flap procedures.

2. Skin Removal After Weight Loss

Such as abdominoplasty (tummy tuck) if skin causes hygiene issues or infections.

3. Cleft Lip and Palate Surgery

Usually performed during childhood to correct congenital deformities.

4. Septoplasty

To correct nasal obstructions that impact breathing, not just for aesthetic reasons.

5. Eyelid Surgery (Blepharoplasty)

Only if drooping eyelids impair vision.

6. Scar Revision

When scarring causes functional issues or significant psychological distress.

7. Facial Reconstruction After Trauma

Following accidents, burns, or injuries affecting function or appearance.

Each case is evaluated individually based on the patient’s condition and medical documentation.

6. What Plastic Surgeries Are NOT Covered?

Medicare will not cover procedures that are purely aesthetic in nature, such as:

Breast enlargement or reduction for cosmetic reasons
Tummy tucks without medical justification
Facelifts
Botox or dermal fillers
Liposuction (unless medically necessary)
Rhinoplasty (if done only for aesthetic reshaping)

If the main reason for surgery is appearance and not function, Medicare won’t pay for it.

7. Eligibility Criteria for Coverage

To qualify for Medicare-covered plastic surgery, you must meet the following:

Australian Citizen or Permanent Resident: Enrolled in Medicare.
Valid Medical Need: Supported by clinical evidence and a specialist referral.
MBS Listed Procedure: The surgery must be included on the Medicare Benefits Schedule.
Prior Approval: In some cases, pre-approval is required before surgery is scheduled.

Your GP or specialist will assess your condition and refer you accordingly.

8. How to Apply for Medicare Plastic Surgery Coverage

Here’s a step-by-step guide to applying:

Consult Your GP
Start with a general practitioner to discuss your symptoms or concerns.
Get a Specialist Referral
You’ll need a referral to a plastic surgeon or relevant specialist.
Confirm the Procedure is MBS-Listed
Your surgeon will check if the surgery is listed and meets the MBS criteria.
Obtain a Quote
Get an itemized quote to understand the full cost and what Medicare will cover.
Submit for Pre-Approval (if required)
Some procedures need Medicare pre-approval, especially reconstructive surgeries.
Claim After Surgery
You can submit your claim through your provider or via the Medicare app or website.

9. The Role of Private Health Insurance

While Medicare may cover part of the procedure, it usually doesn’t cover:

Private hospital fees
Surgeon’s gap fees
Anaesthetist costs
Post-operative care

That’s where private health insurance comes in. Many Australians use a combination of Medicare and private health cover to reduce out-of-pocket expenses. Make sure your policy includes plastic and reconstructive surgery coverage.

10. Choosing the Right Plastic Surgeon

When seeking Medicare-covered plastic surgery, it’s important to:

Choose a board-certified plastic surgeon
Confirm the surgeon is Medicare-approved
Discuss all medical and financial aspects beforehand
Review their previous work and patient testimonials

At BB Clinic, our experienced plastic surgeons are fully qualified and committed to patient-focused care. We guide you through every step—from consultation to recovery.

11. FAQs About Medicare and Plastic Surgery

Q1: Can I get a tummy tuck covered by Medicare?

Yes, if it’s required due to post-pregnancy or post-weight loss complications like rashes or infections. You must meet specific MBS criteria.

Q2: Is breast reduction ever covered?

Yes, if you suffer from chronic pain, skin irritation, or other medical problems due to breast size.

Q3: How much does Medicare reimburse?

It varies. Medicare usually covers 75% of the MBS fee for procedures in a private hospital and 100% in a public hospital. Extra costs may apply.

Q4: Does BB Clinic accept Medicare referrals?

Yes. BB Clinic works with eligible patients and provides guidance through the Medicare process for approved surgeries.

12. Final Thoughts

So, does Medicare cover plastic surgery? The answer is yes—when it’s medically necessary. Whether you’re dealing with post-weight loss excess skin, breathing issues, or trauma-related defects, Medicare may offer support.