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?

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7 Doctor Answers | Asked by Violet Chic in Chicago

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Insurance implications with breast reconstruction

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... more

Medicare Covers Breast Reconstruction after Mastectomy

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

Breast reconstruction and Medicare

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

Steven Wallach, MD

12 reviews

Manhattan Plastic Surgeon

Breast reconstruction is covered by Medicare

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.

Medicare covers breast reconstruction

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

Yes, Medicare will cover Breast Reconstruction

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.

Medicare covers breast cancer reconstruction

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.