Is Blepharoplasty Covered by Insurance? Yes, in Certain Cases.

Woman smiling, portrait, close-up

Most of the blepharoplasty patients I see at my Toronto and Oshawa, ON, practice undergo the procedure for cosmetic reasons. Excess drooping skin creates the appearance of being constantly tired or generally looking older, and patients want to look refreshed and more youthful.

But for some patients, blepharoplasty, often called eyelid surgery, takes on a bit more urgency, such as when that droopy, excess eyelid skin sags enough to significantly impair their vision. In those cases, health insurance will cover the costs of upper eyelid surgery. (In a recent blog post, I broke down the costs of different types of eyelid surgery, including upper blepharoplasty.)

When is eyelid surgery covered?

Qualifying to have insurance cover the cost of upper eyelid surgery involves meeting certain criteria. The procedure must be deemed “medically necessary,” rather than performed for cosmetic reasons. A few points to consider as you think about whether insurance is likely to cover your specific case:

  • If your vision is significantly and unambiguously inhibited by the presence of excess eyelid skin (dermatochalasis) from the upper eyelid, the procedure will be covered by insurance.
  • In order to gain insurance coverage, you’ll also need to have a documented examination by a physician. You may also need to have a visual field test that demonstrates markedly improved vision when the eyelid skin is temporarily taped out of the way.
  • Insurance typically does not cover lower eyelid surgery.

If you are getting upper eyelid surgery to improve your field of vision, the Ministry of Health in Ontario will cover the cost, provided that an optometrist documents at least a 50% reduction in your visual field.

Will it be covered if I have lower eyelid surgery too?

In many cases, a patient whose upper eyelid surgery is being covered by insurance decides to have lower blepharoplasty performed during the same operation. That’s perfectly fine, but only the upper eyelid surgery is covered by insurance.

How do I find out if my eyelid surgery would qualify?

If you’re not sure whether you qualify for insurance to cover the cost of upper blepharoplasty, the first step is to schedule an appointment with an optometrist to test your field of vision.

If you’d like to talk with me about eyelid surgery in Toronto, contact us online or call (416) 925-7337 to schedule a consultation. To see results of some of my actual eyelid surgery patients, visit my online gallery of before & after photos.

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