Is Eyelid Surgery Covered by Insurance?

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Posted by: Missouri Eye Institute in Blog on April 1, 2025

Eyelid surgery, or blepharoplasty, is a procedure that involves the removal of excess skin and fat from the upper and/or lower eyelids to restore vision or improve their appearance. Keep reading to learn more about the types of eyelid surgeries and whether they are covered by insurance!

What Are the Different Types of Eyelid Surgery?

Insurance companies classify most eyelid surgeries into two categories: cosmetic and functional.

Cosmetic eyelid surgery is an elective procedure used to enhance the appearance of the area around a person’s eyes.

Functional eyelid surgery is a medically necessary procedure to restore vision impaired by drooping or excess skin on the upper lids, a condition called ptosis. As people age and their skin loses elasticity, the skin around the eyes can droop over the eyes, blocking their full range of vision.

Because cosmetic eyelid surgery is elective, it is rarely covered by insurance, and the patient is responsible for the full cost. Functional eyelid surgery, on the other hand, is usually a medically necessary procedure that is covered as long as it meets an insurer’s requirements.

Requirements for Insurance Coverage

Whether functional eyelid surgery is covered often depends on whether a patient meets specific requirements set by insurers. These requirements can vary by insurance provider and individual plans, but most require the following:

Medical Documentation

To prove that the surgery is medically necessary, patients should provide detailed documentation of their condition from their ophthalmologist or plastic surgeon. This documentation might include observations made during a physical examination, photographs showing drooping eyelids, and any records of resulting visual impairment.

Vision Assessment

Insurance providers may require vision tests that assess the extent of visual impairment caused by drooping eyelids. One of the most important ways to evaluate impairment is a visual field test, which can determine how much of a patient’s range of vision is blocked by excess skin.

Pre-Authorization

Before agreeing to cover the surgery, insurance providers usually require patients to submit their medical documentation and vision assessment for review. Before the procedure can be scheduled, the insurer will evaluate whether the surgery meets their criteria for medical necessity.

Meeting Criteria

Insurance companies generally have specific criteria that patients must meet for an eyelid surgery to be covered. For example, some insurers may require proof that drooping skin has impaired vision by a certain percentage or caused significant visual limitations.

FAQ About Eyelid Surgery and Insurance Coverage

In addition to insurance coverage for eyelid surgery, here are some other commonly asked questions:

What Eye Conditions Might Make Eyelid Surgery Medically Necessary?

Eyelid surgery is an umbrella term that covers many procedures. However, the most common procedure people are referencing when discussing eyelid surgery is blepharoplasty. Other types of eyelid surgery, including ptosis repair or ectropion/entropion repair, can also be considered medically necessary.

Does Medicare Cover Eyelid Surgery?

Medicare only covers functional eye surgery deemed a medical necessity. It does not cover cosmetic blepharoplasty.

Are There Age Restrictions For Eyelid Surgery?

There are no age restrictions for eyelid surgery, although it is unlikely to be recommended to younger patients unless it is medically necessary. Younger patients might need the procedure to correct an eyelid issue that was present from birth or one that was caused by trauma to the eye.

What is the Success Rate of Eyelid Surgery for Ptosis?

The success rate for eyelid surgeries for ptosis is between 80-90%. The surgery delivers the best results in cases of mild-to-moderate ptosis. Eye doctors often recommend ptosis repair in combination with blepharoplasty if excess skin or fat is present.

If drooping eyelids affect the appearance of your eyes or the range of your vision, eyelid surgery is an effective treatment. While most insurers will not cover the procedure if it is done for cosmetic reasons, they will usually cover all the costs when it is considered a medical necessity.

Do you want to learn more about eyelid surgery or determine if your case might be medically necessary? Schedule an appointment at Missouri Eye Institute in Springfield, MO, today!