Will Medicaid Cover a Breast Reduction in Illinois?

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.

Doctor Answers 7

Medicaid Coverage for Breast Reduction in Illinois

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.

West Palm Beach Plastic Surgeon
4.5 out of 5 stars 39 reviews

Insurance coverage

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

C. Bob Basu, MD, FACS
Houston Plastic Surgeon
4.7 out of 5 stars 209 reviews

Breast Reduction?

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.

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

Breast Reduction and Insurance Coverage

Dear itsme21,

Yikes!  I think anyone would agree that that's pretty large! 

Insurance coverage for breast reduction varies widely from plan to plan but, in general, the larger you are (relative to your overall body size, or body mass index) the more likely they are to be willing to cover it (ie, pay for it).  That's the good news.

The bad news is that you now have to find a surgeon who would be willing to accept the insurance payment as an adequate payment for the surgery.  Unfortunately, as payment for this procedure has dropped over the last few years, there are fewer and fewer surgeons who are willing to do so.

Your best bet is probably to contact a local medical center and see if there is a plastic surgery clinic.  You will probably be able to get it done that way, although I cannot, of course, give any specifics without being able to examine you.

But I hope that this helps, and good luck,

Dr. E

Alan M. Engler, MD, FACS
New York Plastic Surgeon
5.0 out of 5 stars 125 reviews

Breast reduction coverage

Every insurance company is a bit different with regards to coverage for a breast reduction. You should contact your insurance company to find out their criteria.

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

Medicaid coverage of breast reduction

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.

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

Medicaid in Illinois and breast reduction

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.

Karol A. Gutowski, MD, FACS
Chicago Plastic Surgeon
4.9 out of 5 stars 68 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.