Will Medicare pay for a tummy tuck?

Asked by: Meta West  |  Last update: June 9, 2025
Score: 4.8/5 (53 votes)

Tummy tucks, or abdominoplasty, are considered cosmetic procedures and are not covered by Medicaid or Medicare unless deemed medically necessary. Dual eligibility for Medicaid and Medicare is possible, with low-income seniors and disabled individuals often meeting the criteria for both programs.

How can I get a tummy tuck covered by Medicare?

Since a tummy tuck is usually considered elective cosmetic surgery, you will have to prove to Medicare that it is a medically necessary procedure. Medical necessity means that your loose skin gets in the way of performing your daily activities. Medicare requires that you have a stable weight for at least six months.

What makes a tummy tuck medically necessary?

What makes your tummy tuck medically necessary? (covered by insurance) 5 things.
  • Treatment of back pain
  • Repairing abdominal wall laxity or diastasis recti
  • improving appearance
  • Treating psychological symptoms.

How do you qualify for a tummy tuck?

The best candidates for abdominoplasty are men or women who are in good physical condition, but are bothered by large fat deposits or loose abdominal skin that does not respond to diet or exercise. People who intend to lose weight, and women who plan future pregnancies, should postpone the surgery.

What reasons will insurance cover tummy tuck?

Usually, tummy tucks are viewed by insurance plans as being a cosmetic procedure. Sometimes if the patient has severe separation of the rectus abdominis muscles resulting in rectus diastasis, ventral hernia, and excess abdominal skin and fat, the tummy tuck procedure may be covered by insurance.

Will insurance pay for a tummy tuck?

18 related questions found

How do most people pay for a tummy tuck?

Credit Cards. Some patients choose to use a credit card to pay for their tummy tuck. While this can be a convenient option, it's essential to consider the interest rates associated with credit card payments. If you plan to use a credit card, look for one with a low-interest rate or a promotional 0% APR offer.

How painful is a tummy tuck?

Based on a scale of 1 to 10, it is common for patients to rate the pain at around 6-7 during the initial few days to a week, gradually decreasing to approximately 3-4 by the second week. It is important to note that pain levels can differ for each person.

How to get a free tummy tuck surgery?

Here are some of the ways to potentially qualify for a free or subsidized tummy tuck: Medical Necessity: If excess abdominal skin causes medical problems like rashes, infections, or back pain, a tummy tuck may be deemed medically necessary. In such cases, your health insurance might cover the procedure.

What are the weight requirements for a tummy tuck?

Many patients ask, “My BMI is 35; can I get a tummy tuck?” Most board-certified plastic surgeons agree that tummy tuck surgery is most safely performed on healthy patients with a BMI below 35. Ideally, you should be within 10 to 15 pounds of your goal weight before surgery.

What makes you not a candidate for tummy tuck?

Patients must be near their ideal weight before undergoing the treatment. Other factors, such as medication use, preexisting health conditions, and being a smoker, can also hinder one's ability to benefit from the treatment.

What no one tells you about a tummy tuck?

One thing that patients often fail to consider is the recovery time. The recovery period following a tummy tuck procedure can last anywhere from one to two weeks (or longer). Patients should keep this in mind leading up to the procedure so that they don't schedule any social gatherings too soon following the treatment.

How to get Medicaid to cover tummy tuck?

Documentation is required to support a request for coverage of an abdominal cosmetic surgery like abdominoplasty. Patients need to provide their medical records and referrals or recommendations from certified plastic surgeons who can explain why the patient needs this type of surgery.

How long is the hospital stay after a tummy tuck?

A tummy tuck is usually an outpatient procedure. This means you can go home after the surgery. You might need to stay in the hospital overnight if you're undergoing more than one type of cosmetic surgery. On the day of your procedure, you'll receive general anesthesia.

What are the four things Medicare doesn't cover?

Some of the items and services Medicare doesn't cover include:
  • Eye exams (for prescription eyeglasses)
  • Long-term care.
  • Cosmetic surgery.
  • Massage therapy.
  • Routine physical exams.
  • Hearing aids and exams for fitting them.

Can a tummy tuck be medically necessary?

A tummy tuck is often seen as a cosmetic procedure designed to improve the appearance of the abdomen. However, there are circumstances where this surgery goes beyond aesthetic enhancement and becomes medically necessary.

How do I know if Medicare will cover a procedure?

2 ways to find out if Medicare covers what you need:
  • Talk to your doctor about why you need certain services or supplies. Ask if Medicare will cover them. What happens if Medicare won't cover a service I need?
  • Check coverage information on your item, service, or supply.

What disqualifies you for a tummy tuck?

What other factors might delay my tummy tuck?
  • Preexisting health issues.
  • Currently smoking or using tobacco products.
  • Obese or overweight.
  • Body Mass Index (BMI) over 30.
  • Any previous clotting issues or surgical complications.
  • Currently taking any medications, anticoagulants, or supplements that might interfere.

How many sizes do you drop with a tummy tuck?

The results of a tummy tuck procedure tend to vary amongst patients because everyone has a different body composition, angles, and features. However, what you can expect from a tummy tuck is to lose anywhere from one to three sizes around your midsection.

Does tummy tuck hurt more than a C-section?

While C-sections are major abdominal surgeries, many women find that the pain associated with them is less intense compared to a tummy tuck. However, this isn't the case for everyone.

Can you get free tummy tuck from Medicare?

In general, Medicare/Medicaid does not cover tummy tucks because they are considered cosmetic procedures. These healthcare programs primarily focus on protecting medically necessary treatments and services.

How do I get my doctor to approve a tummy tuck?

To increase your chances of getting a tummy tuck covered by insurance, you'll need to meet specific requirements: Medical Necessity – your surgeon must document the medical necessity of the procedure, outlining how the excess skin or abdominal wall laxity negatively impacts your physical health and quality of life.

How do people afford tummy tucks?

Many women finance their Mommy Makeover procedures using personal loans, credit cards, or healthcare financing companies. Others use savings or arrange to pay for their procedures in installments. Although a Mommy Makeover is a big investment, it can actually be more affordable and cost-effective than you may think.

At what age should you not have a tummy tuck?

Strengthening the abdominal wall also helps improve comfort and balance, and can help ensure ideal posture as you age. This is just as important for people in their 20s as people 50 and older, making tummy tuck a suitable treatment for ideal candidates of all ages.

Is there an alternative to tummy tuck?

Vaser Liposuction

This treatment is a minimally invasive tummy tuck alternative that allows for a decrease in fat, while smoothing and slimming the tummy area. Vaser Lipo is more gentle than traditional liposuction, because we begin by carefully dislodging the fat using ultrasound.

Does your stomach go flat after a tummy tuck?

Even in most normal weight and extremely fit women, the abdomen may not be completely flat following abdominoplasty. It is realistic for patients to expect improvement in the flatness of the stomach, but should not immediately assume that their abdomen will be entirely flat.