Most Common Operations Medicare Doesn’t Cover for Seniors
Medicare covers many of the costs of medically necessary surgery for seniors, but many types of operations are excluded from coverage. As a general rule, elective surgery including cosmetic surgery is not covered by Medicare. If a procedure is considered medically necessary, it will usually be approved. Of course, sometimes this means seniors need to wait until their condition progresses to the point of actually requiring surgery rather than having it sooner when it’s only considered elective or voluntary.
The following are some of the most common surgeries for seniors that Medicare won’t cover, or will only cover in limited cases.
Lasik Eye Surgery: Never Covered
LASIK is the most commonly performed laser eye procedure to treat astigmatism, farsightedness, and nearsightedness. While Medicare does cover cataract surgery, it never covers LASIK surgery which is always considered elective as patients can instead use eyeglasses to improve vision.
Eyelid Lift or Blepharoplasty: Sometimes
Medicare won’t cover cosmetic surgery unless it’s considered medically necessary. Blepharoplasty, also known as an eyelid lift, is usually cosmetic but it can be considered a necessary medical procedure when the eyelids impair vision. In this case, a vision field test performed by an ophthalmologist may be necessary to determine if drooping or heavy eyelids are causing your vision issues.
Medicare considers several factors before approving blepharoplasty:
- The amount of visible excess skin of the upper eyelids
- A minimum of 30% visual field obstruction after a vision field test
- Photographs before surgery and documentation of vision issues
- The recommendation for surgery by a doctor who has examined you
Bariatric Surgery: Sometimes
Bariatric or weight loss surgery is sometimes covered but there are requirements that must be met for coverage. Medicare only covers three types of bariatric surgery:
- Laparoscopic adjustable gastric band which uses a band to reduce the size of the stomach.
- Laparoscopic or open biliopancreatic diversion, a surgical technique that bypasses most of the small intestine and diverts digestive fluid from the pancreas and liver to the lower intestine.
- Roux-en-Y bypass, a technique that uses staples to create a smaller pouch in the stomach.
Before Medicare will approve bariatric surgery, candidates usually need to participate in a supervised weight loss program for six months. Most people also need to have a BMI of at least 35 and at least one obesity-related health condition such as diabetes or high blood pressure.
Varicose Vein Removal: Sometimes
Varicose veins are enlarged veins that usually affect the legs and appear dark blue or purple. They occur when a vein valve fails to work correctly and prevents blood from flowing as it should. Varicose veins may begin as a cosmetic problem but, as they worsen, lead to swelling, pain, and aches. They may also cause varicose ulcers or even rupture.
When varicose veins are not causing severe symptoms, Medicare generally does not cover varicose vein removal or treatment. Until symptoms become more serious, treatment is considered cosmetic. Medicare also usually requires candidates try conservative treatments for several months before receiving varicose vein surgery. This may include weight loss and exercise, elevation, and compression sleeves.