This article covers the specific criteria for Medicare Cover of a Tummy Tuck or Abdominoplasty.
Abdominoplasty is a surgical procedure performed to remove excess skin and fat after pregnancy or weight loss. The abdominoplasty procedure can make your abdomen look more sculpted and well-defined. These new contours of your body are can help to improve your self-image and self-worth.
Abdominoplasty is more commonly known as tummy tuck and it can also be performed to remove excess skin after multiple pregnancies. A tummy tuck can improve the look of your body and give you the confidence to wear the type of clothing that you wish to. Research has also shown abdominoplasty can help relieve incontinence and posture problems.
You may be an ideal candidate for an abdominoplasty procedure if you have recently lost a significant amount of weight and are now maintaining a stable weight. Along with that, you should be a non-smoker and have realistic goals and expectations from the procedure. All of these criteria will be discussed during your consultation with Dr Mark Doyle, Specialist Plastic Surgeon.
Medicare will only contribute to a portion of procedures performed due to medical reasons, hence, it does not cover abdominoplasty procedures for cosmetic purposes. Abdominoplasty or tummy tuck is a procedure that can improve the appearance of the body but also has medical benefits.
The presence of excess saggy skin can result in medical conditions like fungal infections in the skin folds or back problems due to the overhanging skin. These potential medical issues may make the tummy tuck procedure a medically necessary procedure. Now that it is a medical procedure, Medicare and your health insurance if you have any, will pay some money towards the costs of the abdominoplasty and other associated procedures if you meet the strict criteria. Please note that there will always be an out of pocket cost for these types of procedures. Costs associated with such a procedure will include surgeons fees, anaesthetist fees and hospital fees.
However, it is important for you to keep in mind that your surgeon will need to provide clear documentation to Medicare as evidence that this procedure is a medical necessity. Book a consultation with Dr Mark, specialist plastic surgeon to find out if you qualify for a medically necessary tummy tuck or panniculectomy procedure.
You may be eligible for a partly medicare-funded tummy tuck procedure if you suffer from any of the following medical issues;
However, you should keep in mind that you have to have tried non-surgical methods of treating the skin infections and rashes, for at least three months with no result for you to be eligible for a Medicare-funded tummy tuck procedure.
For Medicare to cover your tummy tuck procedure, you must have lost a significant amount of weight, which is defined as losing at least 5 BMI points. Basically, if you have lost around 10 kgs to 15 kgs of weight in a short period of time, you may be eligible for a medicare funded tummy tuck procedure.
Another important eligibility criteria is that you must maintain a steady weight after losing weight to be considered for Medicare coverage. You must maintain a steady weight with minimal fluctuations for at least six months. If you can’t show that you have achieved a stable weight, then the chances of getting your procedure covered by Medicare are reduced.
You will also need to prove that the excess skin is affecting your daily life and non-surgical treatments have not yielded any positive results.
It is important to note that these numbers are subject to change and you should speak to your doctor in-depth and research the MBS online criteria to make sure that the numbers have not changed.
You should be prepared to fill in the paperwork and spend time on the phone to get the medicare rebates for your procedure. You will need to meet the eligibility criteria, with actual evidence.
The evidence here is documentation from your doctor that you have tried other non-surgical methods to improve the quality of life with little to no results. You will also need to provide proof that you haven’t had weight fluctuations in the last six months.
You should also know that Medicare or any other insurance provider will not completely fund your procedure. This means that there may be some additional costs that you will have to pay out of your pocket.
If you get Medicare coverage then you may be eligible for Private Health Insurance coverage too. It is very important for you to check your health insurance coverage plan as each plan is unique and different from other funds. You will typically need GOLD level cover to be funded for most plastic surgery. Hospital costs can be very expensive with this procedure but are often covered by health insurance if there is medicare coverage.
Medicare generally covers any procedure that is medically necessary and results in improved health. This may include certain other plastic surgery procedures, but they usually have very strict eligibility criteria that you will need to meet. Moreover, it is usual that the entire procedure won’t be covered but rather just part of it.
Some of the many plastic and reconstructive procedures that have Medicare rebates are mentioned below:
Unfortunately, the post-pregnancy tummy tuck procedure for saggy stretched tummy skin is rarely covered by Medicare as it is not seen as medically necessary and has few medical consequences. However, if you are thinking of undergoing a surgical procedure due to separation of muscles or urinary incontinence due to pregnancy, then there is a chance that Medicare may cover part of your procedure. Talk to you Dr Mark to find out more.
Abdominoplasty procedure can be an outpatient procedure, but most patients are kept in the hospital overnight for monitoring and you will be discharged the next day. Your private health insurance may help cover your hospital costs if you meet the Medicare coverage criteria.
You need to discuss this with your surgeon and health insurance company before undergoing the procedure.
An Abdominoplasty procedure takes anywhere between two hours and three hours depending on the amount of excess skin and consequently, the type of abdominoplasty procedure you are undergoing.
The Abdominoplasty procedure is performed for the purpose of removing excess skin from your abdominal region and to help make it look firmer and sculpted. Commonly, liposuction, which is a body sculpting procedure that helps remove some stubborn fat, is often performed at the same time to improve abdominal contours.
If you’d like to find out more, book a detailed consultation with Specialist Plastic Surgeon, Dr Mark Doyle.
Dr Mark Doyle is a fully qualified Specialist Plastic Surgeon with over 30 years of experience performing breast, body, face and nose surgery. He has completed all required training and only carries out approved surgical practices. There are NO undertrained doctors or cosmetic doctors acting as surgeons at Gold Coast Plastic Surgery.