Can I Claim A Medicare Rebate For My Abdominoplasty?

 Did you know your private health insurance may cover you or offer you a rebate for your tummy tuck (abdominoplasty) procedure? You may also be eligible for a partial rebate from Medicare. Medicare and private health insurance may cover some of the costs of an abdominoplasty (tummy tuck), but you must be prepared for some out-of-pocket expenses.

Why Do You Need a Tummy Tuck Procedure?

There are often a number of crucial reasons for wanting abdominoplasty surgery including:

  • To tighten or remove excess skin after pregnancy or a significant loss of weight
  • Reduce the amount of fat within the stomach area
  • Improve the performance of the muscles
  • Have a flatter, more toned stomach.
  • Help certain muscular diseases that might affect how the abdominal muscles perform

Medicare Rebate

Will Medicare cover my Tummy Tuck?

It is possible, after having major weight loss or conditions that require surgery for medical reasons, that Medicare will cover some of your procedure. If the surgery is thought to be medically necessary and meets strict Medicare criteria (not everyone will), a rebate may be granted. In these cases, Dr Craig Rubinstein will need to assess if an abdominoplasty could have any negative impacts to your health.

To be eligible to claim Medicare item 30177, as with any other Medicare rebate, visit your GP or other specialist and ask for a referral to Dr Craig Rubinstein specialist.

Medicare rebate schedules can change suddenly and without notice. There may be sudden changes in your cover, so be aware of your Medicare and private insurance cover requirements.

Why is the Medicare Rebate Question So Confusing?

The answer to this question can often be confusing for most patients seeking cosmetic surgery. This is due to the fact the rebate will vary depending on the patient and the procedure required.

Medicare will sometimes offer a minor rebate on some procedures. Further, rebates are generally available only for reconstructive plastic surgery or what is deemed ‘essential’ surgery. Not all abdominoplasty surgery falls under this category; but some surgeries may, you need to check with your GP for a referral.

When it comes to plastic and cosmetic surgery, the Medicare rebate guidelines are very clear. Medicare will not cover ‘non-therapeutic cosmetic surgery’ or ‘non-therapeutic plastic surgery’ procedures.

Medicare Rebate

What Other Plastic Surgery Procedures Might Medicare Cover or Provide Rebates for?

The answer to this will vary. It depends on the patient’s needs and other health factors. Medicare will sometimes offer partial rebates on:

  • Facial or nasal reconstructive plastic surgery after trauma or an accident
  • Rhinoplasty (nasal reshaping) to rectify an obstructed nasal passage (corrective rhinoplasty)
  • Rhinoplasty for impaired breathing from a nose injury, deviated septum or other nasal structural abnormality
  • Breast reconstruction surgery following a mastectomy and\or breast cancer treatments
  • Breast prosthesis following a mastectomy or other breast cancer treatments
  • Skin ‘tightening’ surgery after rapid weight loss or bariatric surgery (surgical excision and reduction of excess skin and/or redundant tissues) such as occurs during abdominoplasty, belt lipectomy or similar procedure.
  • Bariatric weight loss surgery for obesity
  • Medically-necessary blepharoplasty (eyelid lift surgery) where sagging upper eyelid skin impedes vision
  • Breast lift or breast reduction surgery (patients must meet very specific criteria)

What Does Medicare Currently Cover?

Medicare currently covers only medical and surgical procedures that are clinically necessary for your health. Further, Medicare won’t cover elective plastic surgery or cosmetic procedures that you choose to pursue for purely cosmetic reasons. This includes procedures such as liposuction on your thighs, or purely cosmetic rhinoplasty.

If you are considering an abdominoplasty or need advice on Medicare rebates for tummy tuck procedures, please contact us for further information.

Please Contact Dr.Rubinstein’s office to book a consultation or enquire about further information regarding plastic surgery procedures.

Dr. Craig Rubinstein’s affiliations include: