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Does Insurance Cover Blepharoplasty?

Home / Laser Eye Surgery Guide 2023 / Does Insurance Cover Blepharoplasty?

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Blepharoplasty insurance coverage only applies when it is considered a “functional” blepharoplasty. This means it is done for medical reasons. A blepharoplasty is not covered when it is performed as an elective cosmetic surgery.

If the skin around your eyelids sags and is impairing your vision and ability to perform daily tasks, a blepharoplasty can be considered medically necessary. Even when a blepharoplasty is covered by insurance, there will often be out-of-pocket expenses you will be responsible for the day of the procedure.

You cannot use health care savings accounts to help with the costs of a cosmetic blepharoplasty, but you can use a credit card or take advantage of special financing through the clinic.

Insurance Coverage for Blepharoplasty

Insurance word written on wood block

A blepharoplasty is one of the most common cosmetic procedures to reduce signs of aging around the eyes, such as droopy eyelids, sagging skin, wrinkles, and bags under the eyes.

The procedure removes excess skin, muscle, and fatty tissue that can cause your eyelids to droop. By reducing droopy eyelids and sagging skin, an eyelid lift can minimize signs of aging and restore a more youthful appearance. It can be done on the upper or lower eyelids, or on both.

Medical insurance does not cover the cost of cosmetic procedures or surgery. If a blepharoplasty is done for cosmetic purposes, it is considered elective and therefore not covered. However, it may be covered when it is done for functional purposes and the blepharoplasty is considered to be medically necessary.

When Blepharoplasty Is Covered

In order for a blepharoplasty to be covered by medical insurance, the eyelid skin must be impairing your field of vision, usually your peripheral, or side, vision.

You will need an eye exam proving your lost field of vision as well as photo documentation and a statement on how your droopy eyelids are impacting your daily life. The eyelid skin must be obstructing your line of sight enough to make it hard for you to go about your daily life. The eyelid skin may droop enough to cover your eyelashes.

Functional blepharoplasties are covered by most major medical insurance companies when the excess eyelid skin impairs your functional vision. The following are examples of when a blepharoplasty can be deemed medically necessary and therefore covered by medical insurance:

  • Your upper and/or outer visual fields are significantly impaired, and the visual field can be improved by at least 15 degrees.
  • Corneal or conjunctiva irritation is caused by the drooping eyelids.
  • Repair for lax muscles is needed due to ptosis.
  • You have difficulty tolerating a prosthetic due to your upper eyelid position.
  • Repair defects are present, caused by tumor-ablative surgery or trauma.
  • You need the surgery to relieve chronic dermatitis, caused by too much eyelid skin that does not respond to alternative treatments.
  • You need relief for painful or visual symptoms of blepharospasm.

Each insurance company has different plans and policies regarding coverage, and you will need to check with your provider directly to learn the specifics of your coverage. Coverage will depend on your plan, location, insurance company and provider, and where the surgery is done.

Out-of-Pocket Expenses With Blepharoplasty

Health insurance blocks

The average cost of a blepharoplasty is over $3,000. This cost does not account for operating room facilities, anesthesia, and additional expenses related to the procedure. Even when the blepharoplasty is covered by insurance, there are usually out-of-pocket expenses involved.

The amount of money you will pay for your blepharoplasty depends on your specific insurance coverage, what your deductible amount is, and any copay fees you may have. Coverage may only extend to the procedure itself and not to other associated costs. Insurance coverage often has a cap, or a maximum amount of coverage, and this procedure can exceed that.

Get a detailed breakdown of costs from your surgeon, and confirm coverage details with your insurance provider, to ensure that you understand all of the potential fees and expenses up front.

Help With Costs Beyond Insurance

The cost of a blepharoplasty can be high, but the end result can offer relief from irritation as well as a more youthful appearance. If your eyelid lift is cosmetic and not covered by your insurance, there are other methods to offset the overall cost.

When a blepharoplasty is done for cosmetic reasons, you cannot use your HSA, FSA, or other health care spending or savings accounts to pay for the procedure. You can use a specialty credit card, such as CareCredit. These cards often give special financing for cosmetic procedures.

Another option is financing the procedure through the clinic or surgery center. Many clinics will offer payment plans and financing options to make the payment process more manageable.

References

  1. Blepharoplasty. (June 2020). Mayo Clinic.
  2. Does Insurance Pay for Eyelid Surgery? (November 2014). American Academy of Ophthalmology (AAO).
  3. Open Your Eyes to Functional Blepharoplasty. (November 2010). Review of Optometry.
  4. Eyelid Surgery. (2020). American Society of Plastic Surgeons.
  5. Eyelid Surgery or Blepharoplasty Cost and Blepharoplasty Financing. (September 2020). Synchrony Bank.

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