Will Medicare Cover Reconstruction After Mastectomy Even if You Are over 70 Years Old?

For patients over 70 years of age who have a mastectomy, will Medicare cover reconstructive surgery at an older age?

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4 Doctor Answers | Asked by hisgracetoyou in Franklin, NC

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Medicare and breast reconstruction

Medicare certainly covers breast reconstruction for patients who have had a mastectomy for breast cancer. The Women's Health and Cancer Rights Act of 1998 (WHCRA) mandates that any insurance company or third party payor that pays for breast cancer treatment is also compelled to pay for reconstruction, as well as for surgery on the non-cancer side is necessary for symmetry.

Medicare pays for breast reconstruction

There is federal law that mandates that insurance pays for breast reconstruction following mastectomy as well as any procedures required to achieve symmetry on the opposite breast, regardless of age. Medicare does not do pre-authorizations, so your physician can't call and obtain pre-approval. Also, medicare typically only will pay for the reconstruction if the mastectomy was was performed for cancer. Hope that this helps!

Does age prevent reconstruction? No

Yes, it is a federal law that reconstruction is a covered benefit after mastectomy regardless of age. Medicare, however, does not pre-approve.

Medicare coverage

Well, Medicare is unusual since it is the only medical coverage that does not allow for doctors to write or call about the approval for a surgery. Your age does not matter with respect to the approval. Since there is a federal law that mandates reconstruction for patients who have had a mastectomy, there would be no reason to think medicare would not cover your surgery. I have never personally seen a denial for this reason.