“Is a Tummy Tuck covered by Medicare” is one of the most commonly asked questions when it comes to plastic surgery and Medicare. There have been so many changes in the last few years with what is and is not covered that it can be hard to keep up and can get confusing. We chatted to Dr Nicholas Moncrieff from Hunter Plastic Surgery in Newcastle about if and when you might be covered by Medicare for a tummy tuck.
A brief history on Tummy Tucks and Medicare
In late 2015 the Federal government released a statement they would be reviewing all 5,700 items on the Medicare Benefits Schedule including tummy tucks and in early 2016 many changes were introduced including much tighter restrictions on who could access rebates for tummy tucks.
Dr Moncrieff says the current situation is that no public hospitals offer free tummy tucks in his region and possibly across Australia. “However, Medicare will provide a modest rebate if you satisfy the weight loss criteria introduced in 2016. Importantly, having Medicare coverage is key to having health fund coverage, which reduces the overall cost.
“For example, tummy tucks through Hunter Plastic Surgery are reduced from $20,000 out of pocket to $13,000.”
When does Medicare cover tummy tuck? What are the criteria?
The Medicare Benefits Schedule states an abdominoplasty (number 30177) is covered in the following circumstances:
(a) there is intertrigo or another skin condition that risks loss of skin integrity and has failed 3 months of conventional (or non surgical) treatment; and
(b) the abdominal apron interferes with the activities of daily living; and
(c) the weight has been stable for at least 6 months following significant weight loss prior to the lipectomy.
Note that the above criteria only applies to those needing the surgery as a direct consequence of significant weight loss. Dr Moncrieff explains further. “You must have had significant weight loss defined as 5 BMI points or more (unrelated to pregnancy). This means most women I see who have experienced a weight loss of at least 15kgs, without weight fluctuations for at least 6 months, meet the weight loss criteria.”
Does Medicare cover a tummy tuck for women post-pregnancy?
In short, sadly not unless they can meet the weight loss rules above.
Dr Moncrieff says that unfortunately this means the Medicare rules don’t provide any assistance for women suffering from muscle separation or excess skin relating to pregnancy. “We have lobbied hard against this unfair rule! We even contributed to a national study of abdominoplasty patients published in 2018 that demonstrated the significant improvements in back pain and incontinence for women who had muscle separation which was repaired during their tummy tuck. The Government is currently reviewing their position on this, but it is uncertain if there will be any movement on this issue.”
So if you think you might be eligible, what’s the next step?
Dr Moncrieff says the best way to start the process to see if you are eligible is to see your GP. “All of the above should be discussed with your referring GP and documented in their referral to us or the surgeon of your choice. If you provide a referral, Medicare will provide you with a rebate of just over $70 towards your consultation.”
About Dr Nick Moncrieff
With nearly 30 years of experience in medicine and surgery, and his exclusive focus on breast and body surgery for women, Dr Moncrieff is one of Australia’s experts in tummy tucks. You can find more information on this topic on the Hunter Plastic Surgery website, or to arrange a consultation with Dr Moncrieff phone (02) 4920 7700.
You can also ask any questions in the comments section of the blog below and Dr Moncrieff or his Practice Manager Jessica will get back to you with an answer.