Will Medicare Cover the Whole Cost of Breast Reduction for a Woman with Size G Breasts?

Question

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

Mark Baldwin, MBBS · Answer

Here in Australia, if you can obtain a referral to the plastic surgery department of a public hospital from your GP, and your surgery is for medical reasons, you could be placed on the public waiting list for surgery and your breast reduction would be done without any cost to you. Unfortunately in 2017, at least in Melbourne, it seems there are very few (if any) public hospital plastic surgery departments who will accept a breast reduction referral. Most hospitals will simply inform your GP that they don't offer breast reduction surgery full stop. 
If you decide to have surgery done privately, and if your surgery is for medical reasons, Medicare will cover a small amount of the overall cost of the procedure. If you have private health insurance, a much larger proportion of the cost (maybe half) would be covered by that insurance. 
You could obtain more accurate information that applies to you personally by speaking to the staff of your local plastic surgery practice, or having a consultation with an experienced surgeon. Remember to ensure they are qualified specialist plastic surgeons and members of the Australian Society of Plastic Surgeons.

Tom J. Pousti, MD · Answer

Thank you for the question and congratulations on your decision to proceed with breast reduction surgery. It is one of the most patient pleasing operations we perform.

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 are  working with a well-trained/experienced board-certified plastic surgeon.

Best wishes.

William Bruno, MD · Answer

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.

	Best wishes,

	Dr.Bruno

Miguel Delgado, MD · Answer

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.

Carmen C. Munteanu, MD, FRACS · Answer

Hello and thank you for the question!
I am not sure about the rules in US, I know that in Australia some public hospitals will accept new patients, if you fit the criteria. For that, you should see a Plastic Surgeon, fully qualified, who will be able to ascertain if you can go on the wait list for the public system.
Otherwise, Medicare can cover some of the expenses, if you have private health insurance.
Good luck and take care!

Will Medicare Cover the Whole Cost of Breast Reduction for a Woman with Size G Breasts?

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Will Medicare Cover the Whole Cost of Breast Reduction for a Woman with Size G Breasts?

Answers (7)

Answer: Breast Reduction and Medicare

Answer: Breast Reduction and Medicare

Answer: Medicare cover breast reduction

Answer: Medicare cover breast reduction

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Recommended reading

Everything you need to know about Breast Reduction

Our mission is to create a world where every investment in modern beauty is Worth It.