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Does Medicare Cover Breast Reconstruction After Mastectomy?

Does Medicare cover Breast reconstructive surgery  after bilateral prophylactic Mastectomy for patients with BRCA positive gene mutation and strong family hx (medical history) of breast cancer?

Doctor Answers (9)

Yes Medicare covers breast reconstruction!

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Please find an experienced Board Certified Plastic Surgeon and member of the Aesthetic Society using the Smart Beauty Guide. These Plastic Surgeons can guide you on all aspects of facial surgery, breast augmentation and body procedures including tummy tucks or mommy makeovers!


Austin Plastic Surgeon
5.0 out of 5 stars 3 reviews

Medicare and breast recon?

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Yes! Under federal law it is covered. Also, any asymmetry is also covered to balance the breasts.

Tampa Plastic Surgeon
4.5 out of 5 stars 12 reviews

Insurance implications with breast reconstruction

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On October 21, 1998, the Women's Health and Cancer Rights Act of 1998, became effective as part of the 1999 Omnibus Consolidated and Emergency Supplemental Appropriation Act. This new federal law requires group health plans and individual health policies that provide coverage for mastectomies to also provide coverage for breast reconstruction in connection with mastectomy.

In accordance with the Women's Health and Cancer Rights Act of 1998, members receiving mastectomy-related services are entitled to the following benefits:

Reconstruction of the breast on which mastectomy has been performed
Surgery and reconstruction of the other breast to produce a symmetrical appearance
Prostheses and treatment of physical complications at all stages of the mastectomy, including lymphedemas
One home health care visit within 48 hours of hospital discharge
Outpatient care following a mastectomy performed in a health care facility
Inpatient skilled nursing facility care in which the length of stay is determined by the treating physician based upon generally accepted criteria for safe discharge
This coverage will be provided in a manner determined in consultation with the attending physician and patient, given that your plastic surgeon accepts your insurance.  

Web reference: http://www.albertandresmd.com

Phoenix Plastic Surgeon
5.0 out of 5 stars 6 reviews

Medicare Covers Breast Reconstruction after Mastectomy

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It is a federal law that Medicare and all insurance companies cover costs for mastectomy and subsequent reconstruction

Orange County Plastic Surgeon
5.0 out of 5 stars 31 reviews

Breast reconstruction and Medicare

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All insurance companies will cover breast reconstruction after mastectomy.  Medicaid will covet this for you.

Manhattan Plastic Surgeon
4.5 out of 5 stars 14 reviews

Breast reconstruction is covered by Medicare

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Yes.  Breast reconstruction and equalizing surgery on the other breast is covered. You should not have any trouble get the procedures done providing that you find a plastic surgeon that accepts your Medicare benefits.

Best wishes.

Atlanta Plastic Surgeon
5.0 out of 5 stars 6 reviews

Medicare covers breast reconstruction

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Dear Violet

Medicare does cover breast reconstruction as well as the procedure on the opposite side to make the breasts even. Many plastic surgeons are willing to accept at least a portion of the costs from medicare and the secondary. There may be some additional fees but you should discuss this with your plastic surgeon in advance.

Good luck. Steven Schuster MD FACS

Boca Raton Plastic Surgeon
4.5 out of 5 stars 2 reviews

Yes, Medicare will cover Breast Reconstruction

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Insurance will cover breast reconstruction following mastectomy. Furthermore, Medicare should also cover any procedure performed on the opposite breast for symmetry purposes. For example, in order to match the reconstructed breast, the opposite breast may require a breast lift or reduction. Medicare and private insurance should cover this as well.

New York Plastic Surgeon

Medicare covers breast cancer reconstruction

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Yes Medicare will cover breast reconstruction following breast cancer reconstruction. However, the fees that they are willing to pay are generally lower than many plastic surgeons are willing to accept. Therefore, many plastic surgeons do not participate nor do they accept assignment for such cases. In these instances, you may likely have to pay out of pocket expenses.

Chicago Plastic Surgeon
5.0 out of 5 stars 39 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.

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