Does Medicare Except Breast Reduction and Tummy Tuck?

Does Medicare and medicaid cover breast reduction tummy tuck if given letters of recommendation from plastic sergent gynecologist and chropracter as proof of needed surgery.

Doctor Answers 4

Medicare and Medicaid cover surgical procedures if they are medically necessary.

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Thank you for your question.

Medicare and Medicaid typically cover breast reduction if it is medically necessary.

Medicare and Medicaid typically cover functional abdominal panniculectomy if it is medically necessary.

A tummy tuck is a cosmetic procedure not covered by Medicare or Medicaid.

Nashville Plastic Surgeon
5.0 out of 5 stars 221 reviews

European insurances always cover breast reductions also hernia abd

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if justified breast reduction is considered  a real  reconstructive surgery and must be covered, TT and procedures like that dont, but if an umbilical hereniae or  rectus muscles diastasis really exists, yes it can be covered  in any serious insurance cy.

Ramon Navarro, MD
Mexico Plastic Surgeon

Can tummy tucks be covered by insurance?

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If a true medical necessity exists and is documented in the medical record then breast reduction and panniculectomy can be covered by insurance.  Notice I wrote panniculectomy, not tummy tuck.  They are different procedures and have different goals and outcomes.  Insurance will sometimes pay for a panniculectomy, but it will not pay for a tummy tuck.

Richard H. Fryer, MD
Salt Lake City Plastic Surgeon
4.9 out of 5 stars 299 reviews

Does Medicare Accept Breast Reduction and Tummy Tuck?

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The short answer is sometimes, and rarely. The hardest part in dealing with Medicare is that they often do not give a determination of coverage prior to the surgery. I have seen them cover breast reductions in the past, and deny them as well. They will not cover a "tummy tuck", which is a truly cosmetic operation, but they might cover a "panniculectomy", which is a very different procedure with very different indications. Your surgeon will be a good source for guiding you on this.

Matthew Concannon, MD
Columbia Plastic Surgeon

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.