5 cosmetic surgeries covered by insurance

By Alpana Mohta, MD, DNB, FEADV, FIADVL, IFAAD | Fact-checked by Barbara Bekiesz
Published April 30, 2024

Key Takeaways

  • Reconstructive surgeries, unlike cosmetic surgeries, are often covered by insurance and focus on correcting physical abnormalities and improving functionality.

  • Top surgeries often covered by insurance include rhinoplasty for functional issues, blepharoplasty for vision impairment, and gender-affirming surgeries.

  • Coverage depends on documenting the surgery's medical necessity, including evidence of unsuccessful non-surgical treatments.

In 2022, the US saw about $26 billion spent on cosmetic surgeries and procedures, per the American Society of Plastic Surgeons (ASPS).[] However, a report from the ASPS on procedural statistics states, “Plastic surgery, except in selective cases, is considered elective and is not covered by insurance,” indicating that a significant proportion of these expenses were out-of-pocket for patients.[]

Elective surgeries for cosmetic enhancement are not eligible for insurance, but procedures deemed “medically necessary” may be included under insurance policies.

Let’s take a closer look at the top-five plastic surgeries that may be covered by insurance.

Defining ‘medically necessary’ 

The AMA distinguishes between reconstructive surgery and cosmetic surgery, a distinction instrumental in insurance coverage decisions.[] 

According to the AMA, “Cosmetic surgery is performed to reshape normal structures of the body in order to improve the patient's appearance and self-esteem. Reconstructive surgery is performed on abnormal structures of the body, including prosthodontic reconstruction (including dental implants) caused by congenital defects, developmental abnormalities, trauma, infection, tumors, or disease. It is generally performed to improve function, but may also be done to approximate a normal appearance.”  

Many plastic surgeries that serve both aesthetic and functional purposes can be covered by insurance if their medical necessity is documented. This includes evidence of unsuccessful non-surgical treatments.

The ASPS offers guidelines for identifying procedures eligible for insurance.[] The following are the procedures most likely to be covered. 


Rhinoplasty, often necessary for functional issues like obstructed airflow, epistaxis, and chronic sinusitis, is usually covered by insurance if it's proven that conservative treatments are ineffective. Septoplasty, which corrects septal deviation to improve nasal patency, is also routinely covered due to its focus on internal structural correction and direct impact on respiratory function. 

However, insurance often doesn't cover rhinoplasty aimed at external aesthetic changes. 

Conversely, rhinoplasty that modifies the external nasal framework for aesthetic enhancement would not be routinely eligible for insurance coverage unless it's integral to nasal function. 

The ASPS requires surgeons to differentiate between reconstructive and cosmetic components in combined nose surgeries, clearly outlining the reconstructive part's proportion and cost for insurance coverage purposes.


Blepharoplasty, often necessitated by dermatochalasis, is not merely a procedure addressing aesthetic alterations but also plays a pivotal role in rectifying vision impairment due to ptosis, blepharochalasis, dermatochalasis, floppy eyelid syndrome, visual field obstructions, and herniated orbital fat. Patients exhibit compromised visual acuity in such clinical scenarios, attributable to redundant periorbital skin.

The surgical intervention involves the excision of superfluous integumentary—restoring ocular functionality and field of vision. Insurance coverage usually extends to the reconstructive aspect of this procedure, while additional esthetic enhancements necessitate out-of-pocket expenses. 

Regardless of the indication, the procedure comes with its list of complications, such as chemosis, suture tunnels or inclusion cysts, asymmetry, dry eye, corneal abrasion, hematoma, and diplopia. 

Abdominoplasty and panniculectomy

For patients with high BMI, often with conditions like type 2 diabetes or heart disease, bariatric surgeries (eg, sleeve gastrectomy, laparoscopic gastric banding, and Roux-en-Y gastric bypass) are usually covered. Criteria often include a BMI of 40+ or 35+ with comorbidities.[]

After substantial weight reduction, surgical interventions like abdominoplasty and panniculectomy may be undertaken.

These have traditionally been categorized under cosmetic surgery, but they are now increasingly recognized for their functional role in enhancing patient well-being.

Post major weight loss, abdominoplasty (tummy tuck) and panniculectomy may be covered by insurance under specific conditions. Although not as routinely covered by insurance as the primary weight loss surgeries, both procedures may attain medical necessity status—warranting insurance coverage—in scenarios where the patient experiences pain, has functional limitations in daily activities, or is predisposed to dermatological complications due to the surplus dermal tissue.


Mammoplasty encompasses surgical procedures altering breast tissue size or shape. Cosmetic breast augmentation isn't covered by health insurance, but the following surgeries are recognized as medically indispensable.

Post-mastectomy breast reconstruction

Under the 1998 WHCRA, health plans covering mastectomy for breast cancer must also fund breast reconstruction, including implants and ancillary procedures for symmetry.[]

Clinical documentation of health complications or unsuccessful alternative therapies is not requisite for these cases. 

Reduction mammoplasty

This is indicated for patients suffering from symptomatic macromastia, causing issues like cervicobrachial pain, neuropathic symptoms, restricted physical activity, mammary discomfort, and cutaneous issues like dermatitis beneath the breasts.[] Insurance approval may come after 6-12 months with documented proof of conservative treatments' ineffectiveness (eg, physical therapy, chiropractic, and orthopedic interventions).

Male breast reduction

The categorization of gynecomastia surgery for male breast reduction as a functional procedure is more complex than for female reduction mammoplasty. Aspects such as pain, discomfort, and potential malignancy warrant insurance coverage. 

Gender-affirming surgeries

Gender-affirming surgeries have witnessed a significant increase in recent years, driven by more extensive literature, research, and improved social climates, which include increased insurance coverage.

The surgeries, categorized into feminizing/masculinizing top, bottom, and head/neck procedures, have shown low serious complication rates within 30 days, indicating their safety.[] Bilateral mastectomy (transmasculine) tends to be covered more frequently by insurers than breast augmentation (transfeminine).[]

However, the criteria for insurance coverage vary significantly across companies and often deviate from World Professional Association for Transgender Health recommendations​​​​.

Coverage details

To establish the medical necessity of a procedure for insurance coverage, HCPs must demonstrate that the surgery directly addresses the patient's quality of life concerns related to a specific body part or health issue. 

Documentation is vital, often requiring evidence like photos, records of unsuccessful non-surgical treatments, and detailed medical necessity letters. Pre-authorization from insurance providers is frequently a prerequisite for coverage.

What this means for you

The delineation between "cosmetic" and "plastic and reconstructive" surgeries is not merely a matter of terminology—it critically influences their eligibility for insurance coverage. Policies can vary widely; to ensure coverage, consult directly with insurance providers and obtain written confirmations to mitigate unforeseen expenses. 

Read Next: The top 5 riskiest cosmetic procedures
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