When planning for abdominoplasty surgery, also called a tummy tuck, Medicare assistance may come into question: Will Medicare cover my surgery?
If you’re thinking about getting a tummy tuck, it’s a good idea to do your research and know what’s involved. Costs are an important thing to consider in order to be aware, prepared, and confident in your decision. This also means you should think about your reasons and goals for surgery, as this will influence the details of your surgical plan, and therefore, your costs.
Let’s explore what kind of tummy tuck Medicare will cover and who qualifies.
What is a tummy tuck?
A tummy tuck is a life-changing surgery that involves removing excess skin and fat from the abdomen. As well as this, most tummy tuck surgeries involve tightening the stomach muscles.
The surgery is often ideal for people who have excess skin due to either weight loss or pregnancy. It removes this skin and fat from the area in order to restore a slimmer and smoother figure and help patients regain their confidence. In cases of weakened muscles, the procedure can also improve muscle function.
Whatever your reasons for seeking surgery, you should always look for a qualified surgeon who can tailor the procedure to you and your body. If you are seeking a tummy tuck, a meeting with Dr Andrew Broadhurst can help clarify your options. Dr Broadhurst is a qualified and skilled plastic surgeon in Brisbane who helps patients achieve their body confidence goals.
Does Medicare cover tummy tuck surgery?
When patients plan for a tummy tuck, Medicare aid is often a pressing question.
In short, Medicare will cover a portion of tummy tuck costs in some cases. This may include surgery for women who have a muscle gap after being pregnant. It can also include people who have excess skin due to losing a large amount of weight. “In other words, if you are seeking surgery for reasons that are purely cosmetic, you will have to pay for surgery from your own pocket.”
As of July 2022, for patients who meet certain criteria related to their tummy tuck, Medicare may offer assistance. However, patients should keep in mind that only a professional can properly assess their condition and decide if they meet these criteria.
If you’re postpartum and suffer from a muscle gap, this may affect your daily life and comfort. The same may be true for people who have lost a large amount of body weight, resulting in loose skin that affects their health and mobility. Since both of these cases are rather natural facts of life, they are actually considered medical matters in Australia, not just cosmetic. As a result, a tummy tuck is now included in the Medicare Benefits Schedule.
So does this mean Medicare will cover my full tummy tuck surgery?
Well, no, not your full surgery. Separate from your surgeon’s fees are your hospital fees as well as anesthetist fees. You will need to consider this when assessing the costs involved. However, if you have Medicare, you can likely acquire a modest rebate for your tummy tuck surgery, if you satisfy one of the following two criteria.
If you are a weight loss patient, you may qualify for Medicare item number 30177 if you:
- Have lost a large amount of weight, equal to 5 BMI points or more (15kgs or more).
- Have not had large fluctuations in weight within the last 12 months.
- Carry weight on the lower abdomen that regular exercise has not been able to remove.
If you are a post-pregnancy patient, you may qualify for a muscle-repair tummy tuck, Medicare item number 30175. That’s only if:
- It has been more than 12 months since you gave birth.
- You have a diastasis (muscle gap) of at least 3cm. Often called “separation,” this is measured by diagnostic imaging. You’ll need a radiologist of your choice to get these measurements prior to your first consultation with your surgeon.
- Have documented symptoms of moderate pain or at least discomfort in the area, and/or low back pain or urinary symptoms likely due to diastasis.
- Can prove unsuccessful attempts at alternative methods for muscle repair, such as physiotherapy. Your GP will advise you on what these alternative options are.
So, the good news is that if your excess abdominal volume is impacting you medically and you are seeking a tummy tuck, Medicare may cover a portion of your surgical fees. It is important to remain realistic and obtain information about separate hospital fees and anesthetist fees.
How do I know if I am eligible?
In order to claim a Medicare tummy tuck, a doctor must consider the surgery medically required. You should keep in mind that only a trained professional can determine whether you qualify. This means to find out if you qualify for either of the two tummy tuck Medicare numbers, you will need to visit a doctor who will assess your condition.
Speaking to a GP is important in order to establish your concerns. The doctor will assess your problem areas and excess skin, as well as any muscle gap you may have due to a past pregnancy. Then, the doctor can provide you with a referral, if required.
When speaking with your GP, you should bring up any health concerns such as skin problems, discomfort, or back pain. This will ensure your symptoms are documented in your referral. After this, you can arrange a consultation with a trained surgeon, such as Dr Broadhurst in Brisbane, and begin planning the procedure.
Frequently Asked Questions
What if I want a tummy tuck for aesthetic reasons?
Medicare does not cover surgeries done for cosmetic reasons. If you are planning to have tummy tuck surgery just to improve your appearance and body image, this makes it an “elective” procedure. And since elective procedures are not medically required, you cannot claim a Medicare rebate. The kind of tummy tuck Medicare covers is either related to post-pregnancy issues such as a muscle gap (30175) or skin removal after massive weight loss (30177).
Who decides if I meet the criteria?
If you are seeking a tummy tuck, Medicare may help you cover the costs, but it is important to understand whether you meet the criteria. You can find out by visiting a doctor who will assess your condition. The GP may then provide a referral to a surgeon.
How long will my referral last?
Your referral from a GP will generally last up to 12 months.
What if my doctor tells me I am not eligible?
Not everyone will be eligible for a tummy tuck Medicare rebate. If you do not meet the criteria, you can still have the surgery. However, you will need to self-fund the full cost.
Also, some women may have diastasis recti but do not qualify for the lower tummy tuck cost Medicare provides. If this applies to you, there may be other solutions. This can include physiotherapy or exercise programs. A doctor will be able to discuss your options with you to help you get the best results.
Have more questions? Speak to Dr Broadhurst for more information
Have you assessed your eligibility for a tummy tuck and are ready to take the final steps in your weight loss journey? Learn more about this life-changing surgery with Dr Broadhurst, experienced Brisbane Plastic Surgeon who aims to give each patient personalised care. Our team is committed to providing excellent results and guiding each patient through the journey to becoming their best selves.
Ready to take the next step? Reach out to our friendly and helpful team to book your consultation!
