Will Medicare and ChampVA Cover Reconstructive Surgery After Preventative Mastectomy?

Women with a significant family history of breast cancer are entitled to prophylactic surgery (such as mastectomy) to surgically decrease their risk of developing breast cancer. 

By law, all insurance companies are required to cover these surgeries (mastectomy) and breast reconstruction.  This includes Medicare and your secondary insurance plan. 

If you do an Internet search of "breast reconstruction law" you will come across the legal history and current law which describes your rights and the history of this ruling from 1998.

Unfortunately not all Physicians accept all types of insurance, particularly Medicare. Decreasing reimbursements for surgery have forced many Doctors to stop taking patients with plans that do not cover their overhead expenses.

You will need to do some homework and find Surgeons who accept your plan, or alternatively, consider accepting some out-of-pocket expenses in order to get the exact procedure and Providers you specifically are seeking.

Karen M. Horton, M.D., M.Sc., F.R.C.S.C.
 

Yes! Under federal law it is covered. Also, any asymmetry is also covered to balance the breasts.

Medicare like other insurances should cover breast reconstruction. Check with your provider as well.  Good luck.

YES! Please discuss with chosen surgeon and his staff so you fully understand the coverages offered. You must be completely covered in writing before having surgery. A verbal OK is not enough. From MIAMI Dr. Darryl J. Blinski, 305 598 0091