When Does Insurance Cover Blepharoplasty?

Blepharoplasty, or eyelid lift surgery, can be performed for both cosmetic and functional reasons. When sagging upper eyelid skin or drooping eyelid muscles begin to block your vision, cause eye fatigue, or create difficulty reading or driving, the procedure may be considered medically necessary — and therefore eligible for insurance coverage.

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The endpoints for a cosmetic blepharoplasty are different than a functional one. Cosmetic blepharoplasty endpoints are appearance in nature taking into account function. The focus of functional blepharoplasty is improvement of vision taking into account appearance. This may mean the procedure may be slightly different since the end goals are different. 

 

Understanding the Difference: Cosmetic vs. Functional Blepharoplasty

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• Cosmetic blepharoplasty is performed to improve appearance — removing excess skin, puffiness, or tired-looking eyes. These procedures are not covered by insurance.

• Functional blepharoplasty is performed to restore vision that is blocked by sagging eyelids or redundant upper eyelid skin (dermatochalasis). When objective testing shows that the drooping eyelid interferes with sight, insurance may approve the surgery.

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Medical Criteria for Insurance Coverage

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Each insurance company has its own policies, but most follow similar guidelines.
To qualify, the following must typically be documented:

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Margin Reflex Distance (MRD1) 

 

This is the distance from the skin edge to the center of the eye. 

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• An MRD1 of 2.0 mm or less often meets medical necessity standards for functional blepharoplasty.

• This is the distance from the skin to the center of the eye 

• If the MRD is not there it doesn't matter what the visual field or symptoms are. 

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Visual Field Testing (Perimetry)

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• A visual field test demonstrates how much of your upper vision is being blocked by the eyelid.

• Usually, a 30% or greater loss of the superior visual field is required.

• When the eyelid is gently lifted (taped test), vision improves significantly, confirming that surgery will restore the field.

 

Photographic Documentation

 

Standardized photographs must clearly show the upper eyelid drooping over the pupil or eyelashes, consistent with functional impairment. It must match the documented MRD.

 

Documented Symptoms

 

Your chart should note one or more of the following:

• Trouble seeing objects above or to the side

• Difficulty reading for long periods

• Eyelid fatigue or strain, especially later in the day

• Needing to lift the brow or forehead to see clearly

• Vision obstruction while driving or walking downstairs

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When these findings are documented of all four criteria, most insurers — including Medicare, Blue Cross, Aetna, Cigna, and United Healthcare — consider upper blepharoplasty medically necessary. 

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What’s Not Covered by Insurance for Blepharoplasty

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Insurance does not cover procedures performed purely for appearance, such as:

• Removing under-eye bags without vision obstruction

• Smoothing fine lines or wrinkles around the eyes

• Creating a higher eyelid crease for cosmetic preference

• Enhancing eyelid symmetry for aesthetic balance

 

These are considered elective cosmetic blepharoplasty procedures.

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Frequently Asked Questions about Blepharoplasty and Insurance

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Will Medicare cover my eyelid surgery?
 

Yes — if your eyelids meet criteria, Medicare typically covers functional blepharoplasty.

 

Do both eyes need to qualify?
 

Usually, yes. However, if one eyelid causes significant obstruction, it may be covered individually.

 

Can I combine cosmetic and functional surgery?

Absolutely. Many patients choose to pay privately for cosmetic enhancements (e.g., lower eyelid bags) while insurance covers the functional upper portion.

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