Is cosmetic surgery covered by insurance?
Procedures to change appearance. Here’s how each kind of plan usually handles it.
- Employer or MarketplaceUsually not covered
No, purely cosmetic procedures aren’t covered.
More details
Reconstructive surgery to restore function or after injury or illness is covered. Breast reduction and eyelid surgery can be covered when they cause documented medical problems. Breast reconstruction after mastectomy must be covered under federal law.
Cost: Fully out of pocket if cosmetic.
- Original MedicareUsually not covered
No, unless needed after an injury or to improve function.
More details
Medicare covers reconstructive surgery and breast reconstruction after mastectomy.
- Medicare AdvantageUsually not covered
No, unless needed after an injury or to improve function.
More details
Medicare covers reconstructive surgery and breast reconstruction after mastectomy. plans don’t have to cover it, but some include it as an extra benefit: check your plan’s .
- MedicaidUsually not covered
No, only reconstructive or medically necessary procedures.
More details
Reconstructive surgery needs the plan’s approval first ().
What usually has to be true
- For reconstructive surgery, your doctor must show the medical reason in writing.
Good to know
- The Women’s Health and Cancer Rights Act requires reconstruction coverage after mastectomy.
Related
- Surgery · Inpatient or same-day surgical procedures.
Sources
Typical rules for 2026 plans, checked against these sources on October 20, 2026. Your plan’s own documents decide.
- 1What Marketplace plans cover
HealthCare.gov
Marketplace plans cover outpatient care, hospitalization, mental health care, prescription drugs, rehabilitation, laboratory services, preventive services, and other essential benefit categories.
- 2Cosmetic surgery
Medicare.gov
Medicare does not cover cosmetic surgery unless it is needed because of accidental injury or to improve the function of a malformed body part; it covers breast prostheses after a mastectomy.
- 3Compare Original Medicare and Medicare Advantage
Medicare.gov
Medicare Advantage plans cover everything Original Medicare covers (except hospice, which Original Medicare continues to pay), usually use provider networks, often require referrals or prior authorization, and may offer extra benefits such as dental, vision, and hearing.
- 4Mandatory and optional Medicaid benefits
Medicaid.gov
States must cover mandatory benefits such as inpatient and outpatient hospital care, physician services, laboratory and X-ray services, home health, and nursing facility care; many other benefits, including adult dental, vision, and prescription drugs coverage details, are state options.
General information about how coverage usually works, not a decision about your plan. Your plan documents and insurer have the final word.