Does Medicare Cover Breast Reconstruction After Mastectomy?

Thankfully, Congress has supported women's right to pursue breast reconstruction by passing the Women's Health and Cancer Rights Act in 1998 and, more recently, the Breast Cancer Patient Education Act.  These acts ensure that all insurance companies cover breast reconstruction for women who have undergone mastectomies.  

Medicare will cover breast reconstruction. Although there is no pre-approval process, coverage is mandated by federal law.

Thank you for your question.  Yes, a bill passed in 1998 mandates insurance coverage for breast reconstruction.  Additionally, it also covers any revisionary or balancing procedures on the opposite side to achieve symmetry.  

On October 21, 1998, the Women's Health and Cancer Rights Act of 1998, became effective as part of the 1999 Omnibus Consolidated and Emergency Supplemental Appropriation Act. This new federal law requires group health plans and individual health policies that provide coverage for mastectomies to also provide coverage for breast reconstruction in connection with mastectomy.

In accordance with the Women's Health and Cancer Rights Act of 1998, members receiving mastectomy-related services are entitled to the following benefits:

Reconstruction of the breast on which mastectomy has been performed
Surgery and reconstruction of the other breast to produce a symmetrical appearance
Prostheses and treatment of physical complications at all stages of the mastectomy, including lymphedemas
One home health care visit within 48 hours of hospital discharge
Outpatient care following a mastectomy performed in a health care facility
Inpatient skilled nursing facility care in which the length of stay is determined by the treating physician based upon generally accepted criteria for safe discharge
This coverage will be provided in a manner determined in consultation with the attending physician and patient, given that your plastic surgeon accepts your insurance.  

It is a federal law that Medicare and all insurance companies cover costs for mastectomy and subsequent reconstruction

Yes.  Breast reconstruction and equalizing surgery on the other breast is covered. You should not have any trouble get the procedures done providing that you find a plastic surgeon that accepts your Medicare benefits.
Best wishes.

Yes Medicare will cover breast reconstruction following breast cancer reconstruction. However, the fees that they are willing to pay are generally lower than many plastic surgeons are willing to accept. Therefore, many plastic surgeons do not participate nor do they accept assignment for such cases. In these instances, you may likely have to pay out of pocket expenses.

Yes. The Women's Health and Cancer Rights Act of 1998, mandates that health insurance covers the reconstruction for a mastectomy. You do not have to be diagnosed with breast cancer . Many women now have risk reduction mastectomies due to a strong family history or a genetic mutation. 

The answer to your question is yes, Medicare does provide
coverage for breast reconstruction after any medically necessary mastectomy
related to breast cancer prevention and/or treatment.  This is because the federal government passed
the Women's
Health and Cancer Rights Act of 1998 mandating that all medical insurance
providers, including Medicare, cover breast reconstruction after mastectomy.  Feel free to contact my office and speak to my
patient care coordinator who specializes in the insurance - breast
reconstruction process.  She will be
happy to assist you during this challenging process and answer any additional
questions you may have.  Be sure to
research for board certified plastic surgeons that have experience performing
breast reconstruction.  I also recommend
reviewing their before and after galleries before scheduling a
consultation.Be well and good luck!@norrisplastic

Please find an experienced Board Certified Plastic Surgeon
and member of the Aesthetic Society using the Smart Beauty Guide. These Plastic Surgeons can guide you on all
aspects of facial surgery, breast augmentation and body procedures including
tummy tucks or mommy makeovers!