Im 21 and Have a Size 38DD Breast Size. Will Medicare Cover a Reduction?

im 21 years old and im 5'3 about 150 pounds and i have a breast size of 38DD and i get back pains and shoulder pains even when i stand for a long time. can you tell me if medicare/hudsonhealth will cover a breast reduction?

Doctor Answers 8

Medicare and breast reduction surgery

Medicare will only pay for a surgery that it deems medically necessary.  There is no pre-approval process with Medicare.  We call it Las Vegas, roll the dice and see if they pay. All that we can do as physicians is to document the problem as with any other patient and try to meet the same criteria as any other insurance company.  Unfortunately with Medicare it is only in retrospect that Medicare determines eligibility.  If they deny payment then they could not only deny payment to the physician but to the hospital as well.  Not a good workable situation for anyone involved.

Atlanta Plastic Surgeon
4.5 out of 5 stars 19 reviews

Breast reduction insurance coverage

Based on your description you may be a good candidate for breast reduction surgery; for  physical and emotional reasons.
The best way to obtain insurance coverage for breast reduction surgery involves some “hoops” to jump through. The more documentation you have (for example, from your primary care doctor, physical therapist, chiropractor etc.) the better when it comes to obtaining insurance “authorization” for the procedure.
This documentation and letter/pictures from your plastic surgeon will help you obtain authorization. Make sure you're  working with a well-trained/experienced board-certified plastic surgeon.
Good luck!

Tom J. Pousti, MD, FACS
San Diego Plastic Surgeon
5.0 out of 5 stars 1,486 reviews

Large Breast

Breast reduction is frequently covered if the problem has been present for more than a year causes neck , back and shoulder pain and has been treated unsuccessfully non surgically. Each insurance plan varies but in your case it is probable Medicaid and not many Plastic Surgeons would take it , you probable could go to a training program and have a good job done by the residency program. 

Walter D. Gracia, MD
Fort Worth Plastic Surgeon
4.7 out of 5 stars 3 reviews

Insurance covergae for a breast reduction

You should check with your insurance plan to figure out what the criteria are to get approval for a breast reduction. The requirements vary from plan to plan.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 28 reviews

Breast Reduction - When will insurance pay for it?

The first question is - Are you a good candidate for Breast Reduction Surgery?  Insurance will generally consider approving Breast Reductions if you have the following criteria:

1) Large breasts that create symptoms that are not relieved by medical treatment for 3 - 6 months.

2) That other causes of the pain have been evaluated - Orthopeadic or Chiropractice evaluation, and physical therapy and weight loss has been tried.

3) That you have large enough breast to remove at least 350 grams or the volume required by Schnur Scale.

Second question - can you find a qualified surgeon willing to do it for what the government pays.  You have to search - In Savannah - of 4 groups, ours is the only one that does Medicaid and almost all patients - because we feel that it is our duty to the community and the patients.  Although if all payers begin paying what Medicaid does - I don't know how long anyone will do this procedure.

Richard Greco, MD
Savannah Plastic Surgeon
5.0 out of 5 stars 23 reviews

Low reimbursement for procedures make it difficult to find surgeons

IT may be difficult to identify a plastic surgeon who is qualified and willing to accept medicaid risks. Unfortunately, even if surgeons were busy enough to do 4 a day, the reimbursements would not be enough to pay the surgeons expenses and he/she would actually lose money. I know that sounds surprising but it is a sad reality.  

Otto Joseph Placik, MD
Chicago Plastic Surgeon
4.9 out of 5 stars 81 reviews

Medicare and Medicaid funding for breast reduction surgery

The public health care programs typically will not pay enough for surgeon fee, facility fee and anesthesia fee to make doing breast reduction surgery cost effective. In our practice, we have had difficulty getting paid at all for breast reduction surgery for Medicare patients in the past- so we just don't offer that service as an option to Medicare patients. Since you are 21 years old, you are not on Medicare- you might have Medicaid insurance. Same problem- not enough reimbursement to cover OR time, OR supplies and after care. Consider seeking out a plastic surgery residency program at an academic medical center in your area (New York has several) and setting up a consultation. You might be able to get your operation done in this setting.

Scott C. Sattler, MD, FACS
Seattle Plastic Surgeon
4.8 out of 5 stars 65 reviews

Im 21 and Have a Size 38DD Breast Size. Will Medicare Cover a Reduction?

Yes if you mean Medicaid Insurance. The problem is finding a boarded plastic surgeon who accepts Medicaid and also a hospital. That combination is very difficult to find. Best of luck. From MIAMI Dr. Darryl J. Blinski 305 598 0091

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.6 out of 5 stars 173 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.