Does Medicare cover breast implant replacement?
Medicare covers breast implant replacement only in specific circumstances. Medicare will cover breast implant removal when it is medically necessary, regardless of the original reason for the implants. The placement of new breast implants is covered by Medicare only when reconstruction is being performed due to a medical condition.
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UPDATED: Jan 21, 2021
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- Medicare covers breast implant replacement when medically necessary
Breast implant replacement for cosmetic purposes is not covered by Medicare
You will have to pay your deductible and coinsurance amounts for the procedure
Does Medicare cover breast implant replacement? There are some situations in which your Medicare plan will pay to replace breast implants. As with all procedures that Medicare covers, the removal of the existing breast implants must be medically necessary. Medicare won’t pay to replace breast implants for cosmetic reasons. The procedure is subject to deductibles and coinsurance.
If you have Medicare Advantage for your health insurance plan, your private insurer will determine what your coverage looks like for a breast implant replacement.
To compare rates for a Medicare plan that covers breast implant replacement, enter your ZIP code now.
What does Medicare cover for breast implant replacement?
Breast implants may be placed for cosmetic purposes or as the result of a mastectomy due to a serious illness like breast cancer. Medicare will cover removal of breast implants even if they were originally placed for cosmetic purposes, as long as the removal is medically necessary. Medicare may not pay to replace the implants unless the original reason for placement was a medical condition.
Some of the medical reasons for which the removal of breast implants may be covered are:
• Painful capsular contracture (ICD-10) with disfigurement
• Implant rupture
• Implant extrusion
• Interference with the diagnosis of breast cancer
• Siliconoma or granuloma
Your doctor will be able to find out how much of the breast implant replacement is covered based on your personal condition.
Because Medicare Advantage plans are administered by private companies, they may have different coverage. They still cover everything Original Medicare does, but may have additional coverage.
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What does a breast implant replacement cost with Medicare?
The cost of surgery to remove and replace breast implants will depend on a number of factors, including the medical reasons for the removal, and whether one or both implants are being replaced.
Both Part A and Part B may be involved in covering the procedure, with Part A covering hospital costs and Part B doctor visits, tests, and outpatient treatments. There are deductibles for Parts A and B, and a 20 percent health care coinsurance for Part B.
If you have a Medicare Supplement plan, it will cover some or all of those out-of-pocket costs.
Medicare Advantage plans will differ in terms of coverage levels and out-of-pocket costs. It’s best to check with your plan provider to find out what your coverage looks like and what you will need to pay.
Does Medicare cover breast implant replacement? The Bottom Line
Medicare will cover breast implant replacement as long as it fits the “medically necessary” requirements. You will be responsible for deductibles and coinsurance. Medicare Supplement insurance can help to pay those costs.
To compare rates on Medicare coverage for breast implant replacement, enter your ZIP code below.