Will Medicaid Cover a Breast Reduction in Illinois?

Question

I am 21 years old I have always had big breasts but after having my son in 2008 they went from a E cup to a 48 L and continues to go up, I have tried to lose weight and my breasts always stay the same, I also have chest and back pains. Will they cover it based on everything I am posting here.

Tom J. Pousti, MD · Answer

Thank you for the question.

	It sounds like you are dealing with  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.

	 I would suggest you do your homework and understand the potential risk and complications associated with breast reduction surgery, including  abnormal scarring. You also understand that further surgery may be necessary in the future (for example if the breasts were to grow in size again).

	Timing of the breast reduction surgery is  based on  the patient's psychosocial place in life and is a very individual- specific decision.  She must be able to accept the scars (which result from the breast reduction surgery)  in exchange for the improvement in size/contour/position of  the breasts.  Some patients choose to have the breast reduction surgery earlier in life; some patients prefer to wait until they are in mature/stable relationships and/or have completed  having pregnancies.

	Given that the results of surgery will be with you for a lifetime  I would suggest you save up and have the procedure done by the best  board certified plastic surgeon you can find.  You may find that most well-trained/experienced board-certified plastic surgeons cannot participate in the Medicaid programs.

	I hope this helps.

Otto Joseph Placik, MD · Answer

IT sounds as if you are a good candidate. The next problem is finding a physician willing to accept these rates as payment in full. You may want to contact one of the university programs for this.

Kris M. Reddy, MD, FACS · Answer

We have insufficient information to answer the question. Consult with 3 board certified plastic surgeons who accept Medicaid in your area to understand your options.

C. Bob Basu, MD, MPH, FACS · Answer

I'm not sure about your state medicaid, but I can comment about private insurance coverage.  Every 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

Karol A. Gutowski, MD, FACS · Answer

Illinois Medicaid does not pre-approve breast reduction and may not pay after surgery. So many patients in this situation discuss a self pay option for this procedure.

Will Medicaid Cover a Breast Reduction in Illinois?

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Answer: Insurance coverage

Answer: Medicaid in Illinois and breast reduction

Answer: Medicaid in Illinois and breast reduction

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Will Medicaid Cover a Breast Reduction in Illinois?

Answers (7)

Answer: Insurance coverage

Answer: Insurance coverage

Answer: Medicaid in Illinois and breast reduction

Answer: Medicaid in Illinois and breast reduction

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Recommended reading

Everything you need to know about Breast Reduction

Our mission is to create a world where every investment in modern beauty is Worth It.