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The rules say that plans must pay for a medical service or item if regular Medicare would pay for it in this case. 
You can find this rule at 42 Code of Federal Regulations (CFR) Section 422.101. 
 
The rules say that Cosmetic surgery is performed to reshape normal structures of the body to improve the 
patient's appearance and self-esteem. 
 
As it regards a Medicare covered benefit the Medicare Internet Only Manual 100-02 Chapter16 states: 
Cosmetic surgery or expenses incurred in connection with such surgery is not covered. Cosmetic surgery 
includes any surgical procedure directed at improving appearance, except when required for the (i.e., as soon as 
medically feasible) repair of accidental injury or for the improvement of the functioning of a malformed body 
member. For example, this exclusion does not apply to surgery in connection with treatment of severe burns or 
repair of the face following a serious automobile accident, or to surgery for therapeutic purposes which 
coincidentally also serves some cosmetic purpose. 
 
Surgery to correct congenital defects, developmental abnormalities, trauma, infections, tumors, or disease may 
be covered when the surgery is considered reconstructive in nature. 
 
Cosmetic surgery performed purely for the purpose of enhancing one's appearance is not eligible for coverage. 
Cosmetic surgery performed to treat psychiatric or emotional problems is not covered. 
 
Corrective facial surgery will be considered cosmetic rather than reconstructive when there is no functional 
impairment present. 
 
If a noncovered cosmetic surgery is performed in the same operative period as a covered surgical procedure, 
benefits will be provided for the covered surgical procedure only. 
 
Benefits may be provided for complications arising from cosmetic surgery. Such complications include 
infection, hemorrhage, or other serious documented medical complication.  
 
 Removal of Breast Implants 
For a patient who has had an implant(s) placed for reconstructive or cosmetic purposes, Medicare considers 
treatment of any one or more of the following conditions to be medically necessary: 
 
    Broken or failed implant 
    Infection 
    Implant extrusion 
    Siliconoma or granuloma 
    Interference with diagnosis of breast cancer 
    Painful capsular contracture with disfigurement 
 
You can find this information in Medicare's Local Coverage Determination (LCD): Plastic Surgery (L35163). 
 
If you want to read these Medicare rules, you can go to this website www.medicareappeal.com. 
 
The Plan contract says that the Plan covers items and services in accordance with Medicare rules. The health 
plan contract says that Cosmetic surgery or procedures are covered if cases of an accidental injury or for 
improvement of the functioning of a malformed body member. Covered for all stages of reconstruction for a 
breast after a mastectomy, as well as for the unaffected breast to produce a symmetrical appearance. The Plan 
will cover reconstructive surgery to correct or repair abnormal structures of the body caused by congenital 
defect, developmental abnormalities, accidental injury, trauma, infection, tumors, or disease, if a network 
physician determines that it is necessary to improve function, or create a normal appearance, to the extent 
possible. You can find this information in Chapter 4 on pages 120-123 of the plan's 2020 Evidence of 
Coverage.