Does insurance cover plastic surgery?
Cosmetic no, reconstructive sometimes — and the criteria are your plan's, not your surgeon's.
Quick answer
Cosmetic surgery is not covered. Reconstruction and medically necessary procedures can be — when your plan's written criteria are met and preauthorization is granted in writing. The same operation can be covered under one plan and denied under another.
Where is the line between cosmetic and covered?
Purpose. Surgery to change appearance is cosmetic and excluded. Surgery that reconstructs after disease or injury, or treats a documented medical condition, can be covered — but only when the plan's criteria are met, which is a plan decision, not a surgeon decision.
What are the main coverage pathways?
Breast reconstruction after mastectomy, which federal law (the Women's Health and Cancer Rights Act) requires group health plans covering mastectomy to cover, including reconstruction and related procedures such as symmetry surgery; skin cancer reconstruction; breast reduction with documented symptoms and failed conservative treatment; septoplasty for a functional breathing problem, as distinct from cosmetic rhinoplasty; eyelid surgery with documented visual-field obstruction; and panniculectomy with documented medical issues. The breast reduction guide covers that pathway in full.
What is preauthorization, and why does it matter?
Preauthorization is the plan's written approval before surgery. Without it, even a qualifying case can be denied, and the bill can land on you in full. Get the approval reference in writing, and check each piece separately: the surgeon, the facility, and anesthesia can each be in network or out of network independently, and each affects what you owe.
What if your request is denied?
Ask for the denial reason in writing — the missing piece is usually specific. Add what is missing and resubmit, and have your surgeon request a peer-to-peer review, where the surgeon discusses the case directly with the plan's medical reviewer. Appeal rights beyond that vary by plan and state; your plan's denial letter must explain the process.
What costs remain even when covered?
Your share: deductibles, copays, and coinsurance, plus any out-of-network splits for facility or anesthesia. Get a written estimate of your out-of-pocket share before surgery, and ask what revision or complication care would cost if it were needed — those are frequently billed separately.
Breast reduction: medical necessity, documentation, and appeals →
HSA and FSA: cosmetic no, medical maybe →
Back to paying for plastic surgery — all options →
General information only, not financial or medical advice. Coverage criteria vary by plan and state and change over time — verify your plan's current criteria and get preauthorization in writing before surgery.
Last reviewed: October 2026.