Hello, I am a 29 year old with medicare. I have disability and that is why I am covered by it. I have size G breasts that cause me a lot of issues. (Rashes/acne, back and neck problems and shoulder/posture problems-pain) I was wondering if medicare would cover a breast reduction for me and if there would be remaining costs. How does the surgery work as far as payment? Do I pay first then possibly get reimbursed? How much is the surgery on average? How do I go about asking and getting it? Thanks
Will Medicare Cover the Whole Cost of Breast Reduction for a Woman with Size G Breasts?
Doctor Answers 5
Medicare will cover breast reduction procedure
Medicare will cover breast reduction procedures if you meet their guidelines. Medicare does NOT pre authorize like other health insurance companies. You will need to go to a plastic surgeon who knows the guidelines to assure coverage. Your photos would indicate that you would benefit from this procedure.
Will insurance cover a breast reduction
You should consult with a board certified plastic surgeon who can submit the appropriate authorization and photos needed to get approved. There is no guarantee that your case will be accepted, as this depends on your individual case (your size and your symptoms). Medicare reimbursement is not very good for plastic surgeons so it may be difficult to find a surgeon in network.
Meet with a few plastic surgeons before you commit to surgery.
Breast reduction and medicare payment
Depending on the individual case -size and weight of the breasts, amount to be removed, medicare may cover their portion of the sugical costs. However, not all plastic surgeons accept medicare payments. Most physicians' offices will let you know prior to the surgery what your costs will be. Please check with your local plastic surgeon to find out what their payment policy is.
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Breast Reduction and Insurance Coverage?
Based on your description you may be a good candidate for breast reduction surgery. The best way to obtain insurance coverage for breast reduction surgery involves some “hoops” to jump through. The more documentation you have (for example, from your primary care doctor, physical therapist, chiropractor etc.) the better when it comes to obtaining insurance “authorization” for the procedure. This documentation and letter/pictures from your plastic surgeon will help you obtain authorization.
You may find that working with Medicare that you will not be able to obtain “preauthorization”.
Make sure you're working with a well-trained/experienced board-certified plastic surgeon.
Breast Reduction and Medicare
It would be hard to find a surgeon that would accept Medicare for a breast reduction surgery because Medicare's reimbursement is very low. You might try a teaching hospital that has a residency program in your state, sometimes they will do surgery at a reduced price or perhaps they might even accept Medicare. If you find a surgeon that will accept Medicare, usually they will bill Medicare first after you have paid any deductible or co-payment that is due. Medicare usually only covers 80%. You might even contact Medicare and see if they might have a referral for you and let you know what costs if any you would be responsible for. The cost can vary greatly depending on your geographical area. As stated above the national average is about $7500.
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.