tummy tuck patient

Is a Tummy Tuck Covered by Medicare?

A tummy tuck is often requested by Sydney women after they have had children or lost a significant amount of weight. The surgery removes loose, excess skin that might be interfering with the body contour while tightening up the abdominal muscles to produce a firmer, flatter midsection. Women who have undergone multiple pregnancies might opt for a tummy tuck to restore their body to its pre-pregnancy form. However, worries over costs might make some women hesitant to schedule a consultation. Will Medicare cover Sydney-based fat reduction like a tummy tuck? The answer depends on many different factors.

Medical vs. Cosmetic: Understanding How Medicare Works

In January 2016, Medicare significantly limited coverage of a tummy tuck to those performed for medical purposes only. If you were pursuing the surgery primarily to flatten out your stomach and improve your body contour, you were likely to pay for your procedure out of pocket when these restrictions went into effect. It also made coverage for the surgery more challenging for the average patient to understand. By distinguishing between the cosmetic and functional benefits of the surgery, you can gain a better overview of how Medicare coverage for a tummy tuck currently works.

The Cosmetic Benefits of a Tummy Tuck

There are many aesthetic reasons to consider a tummy tuck:

  • Flattens the midsection for a more attractive body contour
  • Removes loose skin to produce a smoother look
  • Tightens up loosened abdominal muscles for superior sculpting
  • Repositions the belly button for a naturally proportionate result
  • Removes stretch marks between the navel and the panty line

For many women, losing weight after pregnancy is only one step in restoring their pre-pregnancy body. Even when the number on the scale comes down, isolated bulges and loose skin continue to prevent them from looking and feeling their best. A surgical tummy tuck may be the most efficient way to put the finishing touches on weight loss efforts and regain a youthful body profile.

The Functional Benefits of a Tummy Tuck

While the cosmetic benefits of a tummy tuck are numerous, there are functional advantages to be achieved with this procedure as well:

  • Repairs abdominal muscles that have torn during pregnancy and childbirth
  • Removes loose skin that can lead to skin irritation and rashes
  • Eliminates skin folds that may prohibit some activities
  • Improves back pain that some women experience after having children
  • Treats some urinary incontinence that is common for women after pregnancies

When these abdominoplasty benefits are achieved, the results entail much more than an enhanced appearance. The elimination of uncomfortable symptoms or conditions can also improve a woman’s health and quality of life overall.

The Cost of a Tummy Tuck

A tummy tuck is one of the more expensive cosmetic procedures performed for a variety of reasons:

  • The surgery is performed under general anaesthesia
  • Operating time is usually three to four hours
  • Patients spend a few nights in the hospital afterward
  • Follow-up care is more extensive

While the costs tend to be greater, the results are also more dramatic and longer-lasting than some other surgical procedures. However, patients that are contemplating the price of a tummy tuck are usually very interested in how they can get Medicare to cover at least a portion of their surgery.

Getting Medicare to Pay

Although it is not as easy to obtain coverage for a tummy tuck since the changes went into effect at the beginning of 2016, there are still scenarios where you might be eligible for some reimbursement of your costs:

  • The abdominoplasty will be used to treat a medical condition, such as an abdominal wall defect
  • The patient has experienced at least five BMI of weight loss
  • Weight has remained stable for at least six months or longer
  • Skin irritation is persistent, despite a minimum of three months of nonsurgical treatment
  • Significant skin folds are interfering with the patient’s ability to participate in activities or daily life

To qualify for coverage, patients will need to meet a set of documented criteria. It is important to note that Medicare also determines coverage from your private insurance to an extent, meaning that if Medicare does not cover your procedure, your private insurance will not provide reimbursement for the cost of your hospital stay. It is essential to discuss your coverage options with both Medicare and your private insurance company before you schedule your surgery, so you know up front what might be covered and what will need to be paid out of pocket.

Abdominoplasty is an effective way to restore the appearance and the function of your midsection. For additional information about potential Medicare coverage, contact My Cosmetic Clinic today on 1300 85 49 89. We will be happy to answer your questions or set up a consultation with Dr Ansari.


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