Will Medicare/caid Pay for Breast Reduction?

asked 1 year ago by Secondstohours in Glens Falls,NY
Latest answer by Tom J. Pousti, MD
Question viewed 262 times
Tags: age 18-24, female, 170-189 lbs

I know this has been asked a few times so sorry in advance but I was wondering if Medicare/caid would cover a breast reduction. I am 21, about 5'3 and weigh about 175 ( I am also not a slender build, I work out and for my body type about 10 pounds over, so I was told) Anyways I have size 40DD. I wouldn't care but I am having back problems and getting dents from my straps. I don't want to go to an A or anything just a little smaller so I don't have pain and I can run/exercise a little easier.

5 answers to Will Medicare/caid Pay for Breast Reduction?

Breast Reduction and Medicare Congress?

Thank you for the question. Generally, breast reduction surgery is “covered” by Medicare for the appropriate candidate. However, Medicaid does not provide “pre-authorization” ( stating that the planned procedure will be a covered procedure, prior to the patient having the procedure). It would be in your best interests to meet with a well experienced board-certified plastic surgeon who can guide you through the process. Although you will have to jump... more

Tom J. Pousti, MD
San Diego Plastic Surgeon

Breast reduction coverage from Medicare/Medicaid

In my experiance the answer is no and yes. Medicare will not give a prior authorization for the surgery. This means they let the surgeon do the surgery and then decide if they will pay for it. I know of no surgeons who are willing to take this risk. In my state Medicaid will give a prior authorization if a letter and photos are submitted and as long as the proper number of grams of tissue are removed from each side, they pay for it. Starting at a 40DD... more

Jeffrey M. Darrow, MD
Boston Plastic Surgeon

Medicare or Medicaid coverage of breast reduction (reduction mammoplasty)

Medicare may cover breast reductions in some instances such as yours. The issue is that Medicaid/Medicare, unlike other insurance companies, will not give offer a resposne or authorization to a predetermination of benefits letter prior to surgery. Therefore, you will never know your coverage until you have the procedure, in which case they reserve the right to deny reimbursement. It is likely that your procedure will be covered. The next decision is if your... more

Otto Joseph Placik, MD
Chicago Plastic Surgeon

Will Medicare/caid Pay for Breast Reduction?

The simple answer is YES. But the real answer is finding both a boarded surgeon who will accept this type of insurance and a hospital that also accepts it. Very hard to get both. From MIAMI Dr. Darryl J. Blinski, 305 598 0091