Will Medicare Cover my Surgery for Droopy Eyelid? (photo)

I had glaucoma surgery 5 years ago. Since than my eyelid been droopy and it getting worst. I have a dr appt in Sept so I want to know if I should ask my eye dr about it. How much would it cost for repair in one eye if it isn't cover? I'm 30 from Houston and kidney transplant patient. I been dealing with it for years and makeup can't seem hide it no more. Thanks in advance for input

Doctor Answers 7

Will Medicare Cover my Surgery for Droopy Eyelid?

You do have significant right upper eyelid ptosis. Medicare may cover it, depending on how much it obstructs your vision, which is determined by a visual field test.  If insurance doesn't cover it, the cost varies $2000-4000. See an oculoplastic surgeon for evaluation.

Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 72 reviews

Functional ptosis of the eyelid will be covered by Medicare.

From your description in the picture it seems likely that Medicare will cover correction of your ptotic right eye.

Vincent N. Zubowicz, MD
Atlanta Plastic Surgeon
4.7 out of 5 stars 35 reviews

Obscured vision from a drooping lid

suggests it will be covered through Medicare.  You do need a visual field exam to document your peripheral vision loss and photos that show your lid encroaching on the pupil.  If you don't meet the criteria this year, you will in short time.  Find a local surgeon who can help you navigate the process of getting this covered as a medically necessary procedure.

Curtis Wong, MD
Redding Plastic Surgeon
4.8 out of 5 stars 33 reviews

Unilateral upper eyelid ptosis

The correction of unilateral upper eyelid ptosis can be a difficult problem.  Consultaton with an experienced occuloplastic or plastic surgeon is indicated.  Insurance coverage can be determined at the time of your consultation.  

Jeffrey Zwiren, MD
Atlanta Plastic Surgeon
4.5 out of 5 stars 19 reviews

Will Medicare Cover my Surgery for Droopy Eyelid?

The short answer is yes. However, as with all insurances, this depends upon exactly what policy you have and what is considered a covered benefit. It is a great idea to have your ptosis evaluated to determine the exact cause of this problem. It can be repaired under local anesthesia or IV sedation. If someone recommends a simple blepharoplasty, move on to the surgeon that recommends a ptosis repair. They are not the same. An oculoplastic surgeon is typically the most experienced at dealing with this type of issue. Stephen Weber MD, FACS   

Stephen Weber, MD, FACS
Denver Facial Plastic Surgeon
4.9 out of 5 stars 129 reviews

This will depend on the policies of the company that administers Medicare in your area.

I recommend asking your glaucoma specialist for a referral to an oculoplastic surgeon.  That way the oculoplastic surgeon will be fully informed regarding your glaucoma status and medical issues.  

Kenneth D. Steinsapir, MD
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Insurance coverage for eyelid surgery.

Ptosis (eyelid droop) repair is typically covered by medical insurance.  Oculoplastic surgeons are in general the most qualified specialists to surgically correct ptosis.

Mario J. Imola, MD, DDS
Denver Facial Plastic Surgeon
4.8 out of 5 stars 116 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.