Does Medicare Cover Breast Reconstruction After Mastectomy?

Thankfully, Congress has supported women's right to pursue breast reconstruction by passing the Women's Health and Cancer Rights Act in 1998 and, more recently, the Breast Cancer Patient Education Act.  These acts ensure that all insurance companies cover breast reconstruction for women who have undergone mastectomies.  

Medicare will cover breast reconstruction. Although there is no pre-approval process, coverage is mandated by federal law.

Thank you for your question.  Yes, a bill passed in 1998 mandates insurance coverage for breast reconstruction.  Additionally, it also covers any revisionary or balancing procedures on the opposite side to achieve symmetry.  

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.  

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