Will Medicaid Pay for 36DDD Breast Reduction (Age 15)?

Question

Im 15. 5'2 and weight 160 pounds. I want a breast reduction my breast are 36DDD. Will my medicaid pay for it?

Otto Joseph Placik, MD · Answer

It is nearly impossible to find this out prior to surgery. Furthermore, it may be difficult to find a surgeon willing to perform this at Medicaid Rates. Lastly, your parents will have to consent.

C. Bob Basu, MD, MPH, FACS · Answer

I am not familiar with Medicaid but can comment on private insurance.  Every private insurance plan has their own unique criteria on whether they will cover a breast reduction.  More and more, we are seeing plans where a breast reduction is not a covered benefit.  If it is a covered benefit, some insurance plans set a minimum required amount of tissue to be remove in order to met their threshold for coverage.  Some set the amount in relation to your BMI (height and weight).  Others require extensive medical records documenting neck pain, back pain, and history of rashes.   The other alternative is to opt for a breast reduction as a self-pay option.   Start by visiting with a board certified plastic surgeon to learn more about your options.

	Best wishes,

	Dr. Basu
	Houston, TX

Tom J. Pousti, MD · Answer

It sounds like you are dealing with juvenile breast hypertrophy along with the physical and psychosocial consequences of this diagnosis. In other words, the breasts are too large for the frame causing  both physical and psychological distress.

	It sounds like you have done your homework and understand the potential risk and consultations associated with breast reduction surgery. You also understand that further surgery may be necessary in the future (for example if the breasts were to grow in size again).

	On the other hand, breast reduction surgery is one of the most patient pleasing operations we perform and I think that for the right teenager (enough symptoms) it may be an excellent option (regardless of the age).

	I would suggest an in-person consultation with a well-trained/experienced board-certified plastic surgeon. Best wishes.

Steven Wallach, MD · Answer

Each insurance company has different criteria regarding approval for breast reduction surgery. You should contact the insurance company.

Carmen Kavali, MD · Answer

Most private carriers will pay for breast reductions if you meet their medical criteria for coverage. However, most will not cover the procedure for women under the age of 18.

	Medicaid policies very from state to state, so you will have to check your policy to see if it covers breast reduction for women under 18, and to see what the specific criteria for coverage are.

	Then, good luck finding a board-certified plastic surgeon who accepts Medicaid. There are some, but you will probably have to make a lot of calls.

Darryl J. Blinski, MD · Answer

Yes but the real issue is finding a boarded plastic surgeon who will accept Medicaids very low payment and a hospital that also accepts Medicaid. Start making calls. From MIAMI Dr. B

Will Medicaid Pay for 36DDD Breast Reduction (Age 15)?

Answers (6)

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