CMS Implements Strict Limits on Medicare Advantage Coverage for Cosmetic Treatments

Understanding the Policy Shift

Since the Bipartisan Budget Act of 2018, Medicare Advantage plans gained the ability to offer supplemental benefits beyond traditional healthcare—specifically services that could help beneficiaries with chronic conditions maintain their functioning and quality of life. Under this framework, insurers began exploring coverage for procedures outside conventional medical care, submitting various proposals to the Centers for Medicare and Medicaid Services (CMS) for approval.

However, this expansion has now hit a regulatory wall. The CMS has established clear boundaries around what constitutes allowable supplemental benefits, effectively closing a door that many plans hoped to open wider.

What’s Being Prohibited

Beginning in 2026, a new amendment to Section § 422.102 will explicitly forbid Medicare Advantage plans from covering several categories of cosmetic procedures:

Banned cosmetic services include:

• Cosmetic surgeries such as facelifts and facial rejuvenation procedures
• Treatments targeting facial wrinkles and age-related lines
• Procedures addressing collagen and fat loss in facial tissue
• Interventions for age-related bone loss

The CMS reasoning is straightforward: these procedures fail to meet the standard of creating “a reasonable expectation of improving or maintaining the health or overall function of the enrollee.” In other words, purely aesthetic treatments—even if they might boost confidence or psychological well-being—don’t qualify under the rules governing supplemental benefits. Past proposals for coverage of botulinum toxin injections and similar cosmetic interventions have been formally rejected under this new interpretation.

The Real Impact: Numbers That Matter

The scope of this ruling becomes apparent when examining usage statistics. According to data from the American Society of Plastic Surgeons, individuals aged 55 and older account for approximately 4.1 million cosmetic procedures annually—a striking 28% increase compared to 2010. This demographic represents a significant portion of the Medicare Advantage population, making the coverage restriction particularly consequential.

For seniors who previously anticipated that their plans might eventually cover these treatments as part of expanded benefits, the new rule represents a significant shift in expectations. Those seeking these procedures will now need to rely on personal savings and careful financial planning rather than insurance coverage.

What This Means Going Forward

The CMS decision reflects a conservative interpretation of what “health maintenance” encompasses under the 2018 expansion. While the policy aims to prevent overextension of insurance coverage into purely cosmetic territory, it also signals that the window for creative supplemental benefits—at least in the aesthetics category—has effectively closed for now. Seniors evaluating their Medicare Advantage options should factor this into their coverage expectations, particularly if age-related facial treatments were part of their anticipated healthcare approach.