Your Insurance: Medicare, Medicare Advantage, and Medicaid

Medicare and Medicaid coverage for coverlipedema.com members is far more complicated than other commercial and government insurance. We can get them to “cover” directly or on a short appeal, as lipedema surgery is not cosmetic or unproven. However, both plans pay surgeons poorly, and most plastic surgeons are unwilling to perform surgery for such low fees.

Options for Medicare, Medicare Advantage, and Medicaid

Most plastic surgeons treating lipedema are non-participating providers. So, getting Medicare to do a single-case agreement is challenging. We cannot do this with traditional Medicare; members must pay the surgeon upfront or switch to a Medicare Advantage plan. Traditional Medicare will reimburse 20 to 25 percent of the surgeon’s fee while fully covering the hospital fees. This could be an option for some members. While we don’t generally recommend Medicare Advantage plans, most cover lipedema surgery. Because of the “right to try” one for a year, you can switch for coverage and then return to traditional Medicare after completing your surgeries. Medicaid has similar challenges with payment rates and non-participating surgeons. While we have successfully negotiated coverage for all our Medicaid members, it takes excessive time and effort.

Pausing New Medicare, Medicare Advantage, and Medicaid Memberships

Because of these challenges, we are pausing taking new Medicare, Medicare Advantage, and Medicaid members starting June 1, 2024. We will begin accepting them again in the fall before open enrollment for 2025. To better serve Medicare and Medicaid members, we will have a dedicated Coverlipedema.com advocate who will work exclusively with them starting in the fall. The new membership fee will be discounted to $899 from $1,399, including all appeals and addressing network issues, which now cost over $800. Third-party payment plans will be available.

We know that our changes will lead to many more women having their safe and effective surgeries covered in the future. In the meantime, we are fully supporting our existing Medicare and Medicaid members.