Medicare no longer covering Abdominoplasty as of 1/1/2016

On Monday 21/12/2015 the Federal Government announced that the Medicare item numbers for abdominoplasty, and related item numbers, are being removed from the Medicare Schedule, effective 1/1/2016. This is contrary to previous advice that this was only being “considered” for mid-2016.

If a procedure is removed from the Medicare schedule, it becomes “cosmetic”, and you will not be able to claim any rebates for the surgery, nor will any private health insurance cover hospital or other expenses.

What does this mean to me:

  • Abdominoplasty (“tummy tuck”) surgery is being removed from the Medicare Schedule from 1/1/2016, except in certain circumstances, and will exclude its use for treating muscle separation and stretched skin following pregnancies.
  • Various clinical indications will need to be demonstrated for use of medicare item numbers following massive weight loss.

Approximately 3,500 abdominoplasty procedures are performed in Australia each year. Medicare’s contribution to this service is approximately $2.5 million each year.

I am considering undergoing abdominoplasty due to pregnancy related body changes. What does this mean for me?

Medicare will not provide a subsidy for abdominoplasty, so:

  1. You will not receive a rebate for the doctor’s fees,
  2. Hospital fees will not be covered by your Private Health Insurance.

This means significantly higher out of pocket expenses for your surgery.

What if I have Private Health Insurance? Shouldn’t they cover my hospital stay?

If Medicare does not subsidise a procedure, then your Private Health Insurance will not cover your hospital stay. This means there will be significant additional costs of around $5,000 to $10,000, as abdominoplasty usually requires a hospital admission of several days.

Why are these changes being proposed?

The Department of Health and Ageing is responsible for the policy development of Medicare and the Australian Government achieving its Health Policy Objectives. Medicare benefits are paid in accordance with the legislation governing Medicare. This almost exclusively targets women who have had children. The changes, in essence, are saying that abdominoplasty following pregnancy is a cosmetic procedure and functional benefit is not achieved following surgery.

When is this happening?

From the 1st of January 2016

What is being done to oppose these changes?

The Australian Society of Plastic Surgeons has protested to the Department of Health and Ageing on the proposed changes. Further, research is currently being undertaken by various bodies to support the functional benefit of abdominoplasty for the Department of Health’s review. The preliminary results from a study being undertaken which Dr Merten and his patients are participating in, show a profound impact on the disability scale, from 22% to 3% for patients experiencing back pain prior to surgery.

You too can help by raising your concerns with a formal complaint to the Department of Health and Ageing, by contacting your local federal member of parliament, and by writing to the Federal Health Minister Sussan Ley at Farrer@aph.gov.au. Full contact details can be found here.

What should I do if I have been considering Abdominoplasty surgery?

For anyone who has been considering undergoing abdominoplasty surgery, particularly post pregnancy, we recommend that you vigorously register your concerns with your parliamentarians or contact media organisations to explain your situation. If you are willing to tell your story to the media, let us know so we can link you with an appropriate media organisation.

If you have any further questions, please feel free to contact our practice on 02 9199 7448 or info@pureaesthetics.com.au.