fbpx

Your Insurance: Medicare and Medicaid

hSAlthough we have successfully obtained coverage for Medicare and Medicaid patients for years, we ask that you consult with a Coverlipedema.com Regional Ambassador before joining. 

Medicaid

We usually have no issue getting someone with Medicaid covered for surgery, as lipedema surgery is not cosmetic or unproven. Sometimes, we need to appeal, and we discount the complete appeal process to only $499 for Medicaid members. The more pressing issue is that most safe and effective plastic surgeons are not in network with insurance, and some Medicaid agencies balk at women leaving the state and paying fairly for surgery. If this happens, we charge another $499 to assist if there is no network surgeon option (There are options that are not public in many states.) We have never failed to get Medicaid to cover, but it takes more time, often requiring engagement with the state Medicaid agency and teamwork between us and the Coverlipedema.com member. 

Medicare

We usually have no issue getting someone with Medicare covered, as lipedema surgery is not cosmetic or unproven. Sometimes, we need to appeal and discount the appeal process to $499 for Medicare members. The more pressing issue is that most safe and effective plastic surgeons are not in network with Medicare and Medicare pays poorly for lipedema surgery. This makes it very difficult to find qualified surgeons.

For regular Medicare patients, we offer two options. (1) See a university-based plastic surgeon who is employed so that what Medicare pays is less important to them. Coverlipedema.com has non-public plastic surgeon options in several states. Or, (2) Use Medicare to pay the hospital charges which are covered and pay a negotiated discount fee to the plastic surgeon.

Medicare Advantage

Medicare Advantage plans are better at covering lipedema as many have coverage policies. With a large university network surgeon who is in-network with Medicare Advantage, patients are able to know in advance that their entire surgery plan is covered. Regular Medicare does not pre-approve the legs and arms. Also, we can often get a Medicare Advantage plan to pay a non-network plastic surgeon fairly. Because of that, patients have more choices and can see plastic surgeons that are closer to their homes.

Contact Us to Discuss Your Options

Medicaid and Medicare coverage is complicated even when using a network plastic surgeon. Please contact us to discuss what your strategy for getting covered will be before joining coverlipedema.com.

This page was updated on 12 March 2022

Your Next Step

Learn about choosing your surgeon.