My Eyelids Are Closing Because of Droopy Upper Lids and I Was Wondering if Medicare Will Pay Surgery?

Doctor Answers 14

Blepharoplasty: Covered by Insurance?

Depending on your type of insurance coverage, and whether you can prove that the surgery is medically necessary, your insurance may cover part of the cost of your blepharoplasty. In the majority of cases, eyelid surgery is deemed a cosmetic procedure that is intended to improve a patient’s appearance. Still, there are certain situations in which a blepharoplasty is considered necessary (like interference with your field of vision) and thus falls under the realm of insurance coverage.

London Facial Plastic Surgeon
5.0 out of 5 stars 142 reviews

Probably not

Unless it's for health reasons, insurance doesn't usually cover eyelid surgery since it's considered cosmetic.  

Jerome Edelstein, MD
Toronto Plastic Surgeon
5.0 out of 5 stars 176 reviews

My eyelids are closing becue of droopy upper lids and I was wondering if MediCare will pay surgery?

Hello! Thank you for your question! Surgical procedures for aesthetic purposes, to improve appearance, are not covered by insurance. Typically, these as well as complications resulting from such procedures are the responsibility of the patient. Procedures that are meant to correct functional issues and those which cause health-related issues should be covered by your insurance as a medical necessity, with proper examination and documentation. Some insurance plans have exclusion criteria for certain procedures. Also, it is an obligation of the surgeon not to attempt to authorize purely cosmetic procedures through insurance.  Often times, MediCare will not cover.  Detailed description of your complaints, testing, examination, and photographs will be requred.  The other issue is that MediCare will not preauthorize, and if they do not cover, the entire costs will be placed on you. 

Discuss your issues and complaints with a board-certified plastic surgeon to discuss these as well as to examine and assist you in deciding which procedure(s) will be the best for you. A discussion of the advantages and disadvantages will take place along with the risks and benefits. Insurance companies will vary on coverage and is always reasonable to discuss your issues with your surgeon and primary care. It would behoove you to get as much information as possible and even call your insurance yourself. Certainly, pay in advance prior to your surgical procedure and options such as financing are available if you qualify. Hope that this helps! Best wishes!

Lewis Albert Andres, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 26 reviews

Will insurance cover upper eyelid surgery?

Medicare and other insurances will cover upper eyelid ptosis repair and blepharoplasty if certain criterion are met.  First, the margin of the upper lid needs to be a certain distance away from the center of the pupil, usually less than 2mm.  Second, visual field testing must demonstrate significant visual field restriction due to the drooping lids.  Finally, some insurance companies will also want to see photographs.  An experienced oculoplastic surgeon should be able to tell you whether your insurance will cover the procedure prior to having it done.

Steven J. Covici, MD
Springfield Oculoplastic Surgeon
4.3 out of 5 stars 15 reviews

Droopy Upper Eyelids Covered by Insurance

   Droopy upper eyelid correction surgery may be covered by insurance provided that documentation of impairment of visual fields can be obtained.  Find the plastic surgeon with best credentials who performs these surgeries every day.

Kenneth B. Hughes, MD
Los Angeles Plastic Surgeon
4.9 out of 5 stars 492 reviews

Medicare often covers eyelid surgery

All insurance carriers including Medicare have guidelines on when they will cover eyelid surgery.  You have to show that it affects the vision in some way.  Your doctor will make measurements of your eyelid position and test your peripheral vision.  They will also take photographs from several angles. These are all used to determine if you qualify.  

Matheson A. Harris, MD
Salt Lake City Oculoplastic Surgeon
5.0 out of 5 stars 6 reviews

It depends on the degree of visual obstruction

There are two conditions that may possibly be covered:

1. Eyelid ptosis [droopy upper eyelid]

2. Excess upper eyelid skin [dermatochalasis] that hangs over lashes into line of sight.


You would need photos and visual fields done by an Ophthalmologists to confirm these findings.

Your best bet would be to see an Oculoplastics surgeon that does this kind of evaluation and surgery day in and day out.

A.J. Amadi, MD
Seattle Oculoplastic Surgeon
5.0 out of 5 stars 37 reviews

Insurance coverage of droopy eyelids

In general insurance is covering less and less of non urgent conditions.  At least in Chicago there has been a trend away from coverage.  Your chances are the best if the droop of your upper lids is a true ptosis.  This means that the margin of the eyelid sits low relative to the pupil when you look straight ahead.  If the problem is just loose overhanging skin, coverage is less likely.  If you want to try for coverage, it will be necessary for you to undergo visual field testing submit photos.  Even then it is far from a sure thing.

John Q. Cook, MD
Chicago Plastic Surgeon
5.0 out of 5 stars 12 reviews

Medicare payment for blepharoptosis

In NY, I have found that Medicare will not automatically cover this procedure. Field of vision studies can easily be faked and this procedure is on the "hit list". They will cover unilateral ptosis repair as the result of stroke, myasthenia gravis, multiple sclerosis, etc.--all conditions that you don't want to have. I have had one bilateral upper lid bleph covered where the upper lid skin literally hung over and obstructed vision. Generally, since Medicare will not preauthorize procedures, patients have to sign the waiver, pay for the surgery and then keep their fingers crossed. I would not accept assignment and assume that it would be covered.

Robert L. Kraft, MD, FACS
New York Plastic Surgeon
5.0 out of 5 stars 40 reviews

Will insurance pay for my eyelid surgery?

dear Charlie


The answer is often times yes. Medicare is actually pretty good about paying for upper eyelid surgery with her before excess skin that is causing visual field loss or true upper eyelid ptosis. In fact there are some lower eyelid conditions that require surgery that Medicare will pay for. Essentially you need to start your evaluation and consultation series with an ophthalmologist who will determine whether or not there is sufficient laxity or ptosis or what have you to justify surgery for functional purposes. Overall the surgery should should be pretty smooth and your recovery should be about 1 to 2 weeks.


I hope that was helpful


Chase Lay, MD

Chase Lay, MD
Bay Area Facial Plastic Surgeon
4.9 out of 5 stars 75 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.