Will Medicare and ChampVA Cover Reconstructive Surgery After Preventative Mastectomy?

Will medicare and ChampVA cover reconstructive breast surgery after having preventative surgery to remove both breast? I live in Florida.

Doctor Answers 4

Medicare and other insurance plans will cover prophylactic (preventative) mastectomy and breast reconstruction

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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.

San Francisco Plastic Surgeon

Champ VA and breast recon coverage

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

Medicare and breast reconstructions

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

Steven Wallach, MD
New York Plastic Surgeon
4.2 out of 5 stars 30 reviews

Medicare and ChampVA Cover Reconstructive Surgery After Preventative Mastectomy

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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

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.