Medical Insurance and a Prophylactic Mastectomy

Your medical insurance should cover the cost of bilateral prophylactic mastectomy and breast reconstruction if you meet of the medical criteria. You should see a breast oncologic surgeon and Plastic surgeon to help you with this situation. This is not a battle to fight by yourself. If you do not get the help you need and deserve, please get another opinion.

Good Luck

Dr Okoro

Simple answer is YES! Medicare will cover the prophylactic mastectomy and reconstruction with your significant family history of breast cancer. It is the law! Please go to a board certified general or plastic surgeon or both to be evaluated. Good Luck!

In most cases with a strong recommendation from your oncologist, internist and general surgeon your prophylactic mastectomy will be covered. What will definitely be covered is your post mastectomy reconstruction. Here is the law:

Women's Rights for Breast Reconstruction  Following Mastectomy

The Federal Women's Health and Cancer Rights Act of 1998 is still the law today

Under the federal Women's Health and Cancer Rights Act of 1998, a yearly notification
of your benefits pertaining to breast reconstruction must be sent to you by your insurance company.
The Women's Health Care Act states that benefits must be provided for:
• Reconstruction of a surgically removed breast
• Surgery and reconstrcution of the other breast to produce a symmetrical appearance
• Prostheses and treatment for physical complications from all stages of a mastectomy, including lymphedema

These benefits are subject to the conditions and terms of your plan, including maximum benefit amounts, deductibles,
copayments, and coinsurance provisions. The benefits are subject to your plan's exclusions and limitations.