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Will Medicare/caid Pay for Breast Reduction?

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.

Doctor Answers (5)

Breast Reduction and Medicare Congress?

+1

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 through some “hoops”, breast reduction tends to be one of the most patient pleasing operations would perform.

Best wishes.


San Diego Plastic Surgeon
5.0 out of 5 stars 751 reviews

Breast reduction coverage from Medicare/Medicaid

+1

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 you should be able to achieve a reduction which leaves you looking proportional.

Jeffrey M. Darrow, MD
Boston Plastic Surgeon
5.0 out of 5 stars 34 reviews

Medicare or Medicaid coverage of breast reduction (reduction mammoplasty)

+1

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 medical health is optimized. The third issue is a matter of risk assesment and you willingness to accept possible complications as a tradeoff for the potential benefits.

IT may be difficult to identify a plastic surgeon who is qualified and willing to accept medicaid risks. Unfortunately, even if surgeons were busy enough to do 4 a day, the reimbursements would not be enough to pay the surgeons expenses and he/she would actually lose money. I know that sounds surprising but it is a sad reality.

Otto Joseph Placik, MD
Chicago Plastic Surgeon
5.0 out of 5 stars 44 reviews

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Will Medicare/caid Pay for Breast Reduction?

+1

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

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.5 out of 5 stars 62 reviews

Medicare and breast reductions

+1

In terms of coverage, you should check with medicare regarding coverage for breast reductions they may cover it.

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 17 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.