Will medicare cover a breast reduction?

I am 5'10" tall weighing 240 and wear a 42 H bra. I have constant back and shoulder pain and irritation under breast. I have even been treated for yeast infection under my breast.

Doctor Answers 5

Will medicare cover a breast reduction?

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. You will do best achieving a long-term stable way prior to proceeding. 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 who can demonstrate significant experience achieving the types of outcomes you will be pleased with.  
Best wishes.

Will medicare cover a breast reduction?

There are several criteria that must be met prior to an insurance company authorizing a breast reduction.  A consultation with a board certified plastic surgeon can help determine if you would be an appropriate candidate for the procedure.  

Josef Hadeed, MD, FACS
Beverly Hills Plastic Surgeon
5.0 out of 5 stars 9 reviews

Will Medicare cover breast reduction?

Unlike private insurance and Medicaid, it is not possible to receive a precertification for surgery through Medicare. What this means is that if your surgeon thinks breast reduction is medically indicated, he or she will perform surgery and bill Medicare. Medicare in turn may or may not cover the operation. But if Medicare does not cover surgery, you cannot be billed. I would recommend seeing a board certified Plastic Surgeon in your area to find out if you are a candidate for surgery.

Best of luck.

Jennifer Greer, MD
Cleveland Plastic Surgeon
4.9 out of 5 stars 7 reviews

Most likely

In my experience, Medicare does not give pre-authorization for medical procedures.

Because of this, it is imperative that meeting criteria for the procedure is well-documented.

If done correctly, this should be a covered benefit as long as you meet the criteria.

Make a consultation with a board-certified plastic surgeon and have them help you through the process.

Best of luck,

Mats Hagstrom, M.D.

Mats Hagstrom, MD
San Francisco Plastic Surgeon
4.8 out of 5 stars 17 reviews

Will medicare cover breast reduction surgery?

Breast reductions can be "covered" under insurance if they are symptomatic. However, this is dependent upon your particular plan and company. Best thing to do is to first call your insurer and ask what their criteria are for coverage. Then, find a board certified plastic surgeon who can submit your photos, consult and any supporting medical records from other physicians that can support your case. Good luck!

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.