I'm 66 years old, do you think Medicare will pay for a tummy tuck?

Question

I’m over weight been that way all my life. I have a bad over hang. I also have a bad back I have spinal stenosis. I feel like my overhang makes my back hurt worse. I know that the insurance company thinks it cosmetic, but if my over hang is hurting my back, do you think they would pay for it? I have lots of paper work from my doctors. I’ve had this back issue for many years.

Ronald J. Edelson, MD · Answer

I seriously doubt that Medicare will cover the procedure.  Because Medicare doesn’t preauthorize procedures there is no way to know for sure ahead of time.  Therefore your surgeon will expect payment ahead of time.  You can always try billing Medicare but your chances of success are slim.

David Finkle, MD · Answer

A tummy tuck which is also referred to as an abdominoplasty is a procedure to enhance the appearance of the abdomen.  It consists of 3 basic steps:
Skin removal and tighteningSubcutaneous fat removalMuscle tighteningThere are many different types of tummy tucks which are customized to each individual. A panniculectomy is a procedure similar to a tummy tuck, but just the skin removal, no muscle repair or subcutaneous fat contouring.  
The recovery is very similar to a C-Section or Hysterectomy recovery.  The first week lifting is limited to 15 lbs maximum and the patients usually walk slowly and bend over.  The second week the weight limitation is increased to 30 pounds and more normal walking.  After the second week many patients return to work if it is more sedentary, active work jobs and heavy lifting, pulling or straining are still difficult for another 2 weeks.  Most women need help with small children for the first week.
There has been a breakthrough in the technology of post op pain relief for tummy tucks.  A new medication is now being used that will provide for 3-4 days of post op pain relief, speeding up the recovery process!  It is called Exparel.
Vigorous physical activity and contact sports are limited for 4-6 weeks.  Everyone's recovery is different, and everyone's tummy tuck is different, the recovery time will vary from individual to individual.
This is a wonderful operation that will make the tummy flat FOREVER, WITHOUT SIT-UPS!!  But, you have to be willing to trade the appearance for the scar, which is long, but well placed, and hidden in all clothing and bathing suits.  Your weight should be stable and finished with child bearing before undergoing this procedure
Please consult with a Board Certified Plastic Surgeon who specializes in body contouring procedures to assure the best possible result.  
Good Luck!

Robert A. Hardesty, MD, FACS · Answer

Dear Ms. Pattistengel, 
 I appreciate how you feel and thank you for your story and questions. Unfortunately with out photos and a exam of your tissues I can can only comment based your story, however I hope you find my comments helpful.Based solely on your story you may benefit from a panneculectomy (removing just the overhanging tissue) than a full abdominoplasty. 
If I understand your question (rephrased: "will insurance cover the costs to make my breasts normal again". And how do I “find” a Plastic Surgeon who will accept my insurance.
Each insurance company covered benefits are a little different how ever most follow the guidelines of the American Medical Association.
Likewise, each physician (despite specialty)make decisions which insurance companies they will contract with based on many factors. 
I have copied directly from the American Medical Association (AMA) 
(1) Our AMA supports the following definitions of "cosmetic" and "reconstructive" surgery: Cosmetic surgery is performed to reshape normal structures of the body in order to improve the patient's appearance and self-esteem. 
Reconstructive surgery is performed on abnormal structures of the body, caused by congenital defects, developmental abnormalities, trauma, infection, tumors or disease. It is generally performed to improve function, but may also be done to approximate a normal appearance.
(2) Our AMA encourages third party payers to use these definitions in determining services eligible for coverage under the plans they offer or administer.(CMS Rep. F, A-89; Reaffirmed: Sunset Report, A-00; Reaffirmed, A-03; Reaffirmed: CMS Rep. 4, A-13).
If you don't qualify you could consider:
1) start a separate savings account (deposit any extra cash or gifts) and watch it grow.
2) ask a different relative (who has good credit scores to counter sign for you)
3)take on a separate job just to add to your separate savings account.
4)Set up “A go fund me account”. 
5)if you live near a University Medical Center, seek out the Plastic Surgery Residents in training. They often discount their services significantly.
6)ask if any in (5) above have seasonal discounts or specials.
Thus, I suggest you  make several appointments with experienced Plastic Surgeons who listens to your specific desires and who are not only Certified by the American Board of Plastic Surgery but in addition ideally a member of the American Society for Aesthetic Plastic Surgery (denoting by membership as having met additional criteria and a focus on Cosmetic Plastic Surgery).
My best wishes,
Dr. R. A. Hardesty, MD, FACS
Diplomate and Certified by the Am. Bd. of Plastic Surgery
Awardee: RealSelf Top 100
wwwimagineplasticsurgery.com
4646 Brockton Ave
Riverside, Ca 92506
(951) 686-7600

Tom J. Pousti, MD · Answer

Unless there is some unusual circumstance, insurance companies (and Medicare) generally do not cover tummy tuck surgery. In other words, insurance companies do not consider this operation medically necessary. Sometimes, however insurance companies will cover excision of lower abdominal wall skin/apron;  this operation is called a panniculectomy.
The panniculectomy operation involves excision of the lower abdominal wall pannus or  overhanging skin/adipose tissue. It is not considered an  aesthetically driven procedure;  it is often performed to help with concerns such as skin breakdown, infections/rashes… 
Best wishes.

Frederic H. Corbin, MD (license restricted) · Answer

Thank you for the question and the simple answer is Probably not!  Medicare and insurance may pay for a panniculectomy if medically necessary (the over hang) but not a full tummy tuck.Dr Corbin

I'm 66 years old, do you think Medicare will pay for a tummy tuck?

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I'm 66 years old, do you think Medicare will pay for a tummy tuck?

Answers (8)

Answer: Do you think Medicare will pay for a tummy tuck?

Answer: Do you think Medicare will pay for a tummy tuck?

Answer: TT

Answer: TT

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Everything you need to know about Tummy Tuck

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