Will Medicare Cover Breast Reduction for a 60 Year Old?

asked 2 years ago by tiggerpunt in USA West Virginia
Latest answer by Tom J. Pousti, MD
Question viewed 2,399 times
Tags: age 55-64, female, DDD cup, F cup, infection, medicare, pain

Hi. I am a 60 year old female with OA, PMR and GCA. I've also had stents placed in the coronary arteries and angioplasty. I am a size 38DDD, could probably go to and F.

I've had a yeast infection under both breast, a constant odor, severe neck and back pain and grooves in both shoulders. Will Medicare cover this procedure?

6 answers to Will Medicare Cover Breast Reduction for a 60 Year Old?

Breast Reduction and Medicare?

Thank you for the question. Given your description, it is very likely that Medicare will cover each breast reduction procedure. Consultation with a well experienced board-certified plastic surgeon will be helpful. Also, consultation with your cardiologist should also be considered for a full workup prior to surgery. Best wishes.

Tom J. Pousti, MD
San Diego Plastic Surgeon

Insurance and breast reduction

Each insurance carrier has different criteria for pre-approval of a breast reduction. You should check with your insurance carrier. Check with medicaid

Steven Wallach, MD
Manhattan Plastic Surgeon

Insurance coverage for breast lift or breast reduction.

Answer by George J. Beraka, MDManhattan Plastic Surgeon80% of breast reduction questions on RealSelf are about insurance coverage. Here are some helpful points. 1) Insurance companies try very hard not to pay for breast reduction, even though they should. Even small breast reductions relieve many symptoms such as back pain and shoulder pain, and even some types of headaches. 2) Very big reductions (like from an F cup to a C cup) will usually be covered. 3) Many policies will pay for breast... more

George J. Beraka, MD
Manhattan Plastic Surgeon

Medicare will cover Breast Reduction if you meet their criteria

Yes, Medicare will cover breast reduction if you meet their criteria. A predetermination letter with photos can help you achieve the ok for the surgery. Your main issue is if you are medically cleared to under go this operation or any operation. Please ckeck with your primary and cardiac docs.

Darryl J. Blinski, MD
Miami Plastic Surgeon

Breast reduction under medicare

I think Dr. Whitt has summarized the salient points excellently. 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.

Otto Joseph Placik, MD
Chicago Plastic Surgeon

Medicare Coverage of Breast Reduction

Medicare will cover reductions in some cases such as yours. The problem is that Medicare, unlike other insurance companies, will not give prior authorization. The other concern in your case is that your history of coronary disease certainly increases your risks of surgery. You should seek a consultation with a plastic surgeon. Following that, you will have to weigh the benefits/risks.

John Whitt, MD
Louisville Plastic Surgeon

Ask a question

Get Free Email Updates