Insurance coverage for Breast Reduction?

I am 37 years old from NJ, 5'3", weighing 140 lbs and wear a 36C. My breasts do not sag at all, yet. I have suffered from back problems for several years, but don't know if it is my breasts. I have always wanted to go to a B cup. Is there any possiblity that medicare would cover that? Also, does this type of breast reduction require the surgeon to remove and re-attach the nipple? Thank you.

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15 answers to “Insurance coverage for Breast Reduction?”

A: Breast lift

By Hisham Seify, MD, PhD - Orange County Plastic Surgeon

Medicare will not cover a very small breast reduction.The back pain might be related to other issues. A breast lift could be the best procedure for you. Best of luck!

A: Will not be covered.

By Sam Speron, MD - Chicago Plastic Surgeon

Hi, Thank you for your question! Medicare would not cover this because in order for a reduction to be medically necessary, you would need to have a significant amount removed, about at least a pound to be exact. Usually, a size DD or larger. Also, it doesn't sound like you would even be a good candidate for a... more

A: Breast reduction and insurance coverage

By Sam Jejurikar, MD - Dallas Plastic Surgeon

As other doctors have stated, it is highly unlikely that an insurance company would cover the cost of your breast reduction. Depending on your geographic location, your body habitus, and your insurance company, your surgeon would likely be required to remove at least 400-500 grams of tissue. ... more

A: Insurance coverage of breast reduction operations

By Michael A. Bogdan, MD - Dallas Plastic Surgeon

In general, insurance companies cover operations that are done to improve your health (not your looks or body proportions.) In relation to breast reductions, the indications for coverage are typically related to neck or back pain from the weight of the breast, or sometimes rashes due to moisture under... more

A: Small breast reductions

By Steven Wallach, MD - Manhattan Plastic Surgeon

To go from a "C" to a "B" it is extremely unlikely that your insurance company will pay for your reduction. Such a small reduction may not improve your back symptoms at all. If the breasts do not sag at all it is unlikely that you would need movement of the nipple areola... more

A: Insurance does not pay for small breast reductions.

By George J. Beraka, MD - Manhattan Plastic Surgeon

Hi! I am afraid no insurance plan will pay for a breast reduction that only takes you down one cup size. Also, it is not likely that your back pain is due to your breasts if you are only a C cup. The good news is that since you have no sagging, and you only want to go from a C cup to a B cup, you sound... more

A: In my opinion, medicare would not likely cover this small of a breast reduction

By Otto Joseph Placik, MD - Chicago Plastic Surgeon

I am from illinois and do not know if the Medicare administrator for your area is different than here. However, with most insurance companies you have the option of submitting a letter to predetermine your beneifts eligibility prior to surgery using photos, history, supporting letters, etc. This is not an... more

A: It all depends on your insurance

By David Shafer, MD - Manhattan Plastic Surgeon

In many cases, health insurance companies will cover breast reduction surgery. However, they often require letters from your doctor and possibly your primary care physician as well. You also often need to have photographs done for their review. Additionally, the insurance companies... more

A: Breast reduction is sometimes covered by insurance.

By George Marosan, MD - Bellevue Plastic Surgeon

You are 37 year old and to be eligible for Medicare coverage you need to be 65. Medicaid covers people who have an income below a certain level. What you describe is not covered by any insurance. Insurance co. have a weight scale table that they use to cover the breast reduction procedure. Based on your height... more

A: You wouldn't qualify for a covered reduction

By Richard P. Rand, MD - Seattle Plastic Surgeon

First of all, you are too small to qualify for a reduction. Most all coverages require at least 500 grams of weight (about a full pound!) of tissue to be removed from each breast to be considered "medically necessary." You certainly don't have that much. Secondly, it may be that... more

More answers to Insurance coverage for Breast Reduction?
Los Angeles - Sounds like you're not qualified for breast reduction...
New Orleans - will not cover
New York City - Medicare coverage
Philadelphia - Breast reduction and Insurance
St. Charles - Unlikely you need breast reduction

Comments

tracey01
2 posts
14 Jul 2009

I forgot to add. My breast size has always remailed the same, even when my weight has dropped to 125 which was to skinny, because I am physically pretty muscular. I could stand to maybe lose 10 lbs, but thats it. My breast size wont go down, it never has. Thank you

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