Does Medicare cover breast reconstruction after a lumpectomy?

Medicare covers breast reconstruction after a lumpectomy or a mastectomy when the treatment is prescribed by a doctor and is not elective. Your Medicare coverage for breast reconstruction includes Part A coverage for inpatient treatment and Part B coverage for doctor visits and outpatient treatment. You may have out-of-pocket costs associated with breast reconstruction surgery under Medicare, but a Medicare Supplement plan can help.

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D. Gilson is a writer and author of essays, poetry, and scholarship that explore the relationship between popular culture, literature, sexuality, and memoir. His latest book is Jesus Freak, with Will Stockton, part of Bloomsbury’s 33 1/3 Series. His other books include I Will Say This Exactly One Time and Crush. His first chapbook, Catch & Release, won the 2012 Robin Becker Prize from Seve...

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Leslie Kasperowicz holds a BA in Social Sciences from the University of Winnipeg. She spent several years as a Farmers Insurance CSR, gaining a solid understanding of insurance products including home, life, auto, and commercial and working directly with insurance customers to understand their needs. She has since used that knowledge in her more than ten years as a writer, largely in the insuranc...

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Reviewed by Leslie Kasperowicz
Farmers CSR for 4 Years

UPDATED: Jan 21, 2021

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The Highlights

  • Medicare covers breast reconstruction surgery after a lumpectomy due to breast cancer
  • Medicare doesn’t cover any breast surgery that is considered cosmetic in nature
  • You will have to pay coinsurance after your deductible is met

Does Medicare cover breast reconstruction after lumpectomy? Medicare will cover any breast reconstruction surgery that is medically necessary as a result of breast cancer surgeries. This includes breast reconstruction after mastectomy and lumpectomy. Your Part A coverage will pay for inpatient hospital costs, while Medicare Part B covers medical costs such as tests and doctor visits. Both parts have a deductible, and Part B has a 20 percent coinsurance. You can supplement your Medicare health insurance with a Medigap (Medicare Supplement) plan that will pay for some or all of these out-of-pocket costs.

To shop for a Medicare plan that covers breast reconstruction surgery after a lumpectomy out-of-pocket expenses, enter your ZIP code.

What coverage does Medicare have for breast reconstruction surgery after a lumpectomy?

Medicare covers treatment for breast cancer, including lumpectomy and mastectomy, and the reconstructive surgery that is required afterward. The breast reconstruction must be medically necessary, but that is rarely in question when it is being done as part of a breast cancer surgery. Your inpatient hospital stay, if needed, will be covered by Medicare Part A. Visits with your doctor, tests, and outpatient treatment will be covered by Part B.

Medicare Advantage plans will differ somewhat in that the coverage is not divided into parts. There are many different plans available, however, all of them will cover your breast reconstruction. Speak to your plan provider for details on your coverage.

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How much does breast reconstruction surgery with Medicare cost?

Your final out-of-pocket costs will depend on several factors, including the complexity of the surgery and the extensiveness of the needed reconstruction. However, you can calculate some of your costs based on how much you need to pay for deductibles and the 20 percent coinsurance amount. You will not have to pay either of those, however, if you choose to buy a Medicare Supplement plan that has coverage for all deductibles and health care coinsurance amounts.

Deductibles and coinsurance will vary with Medicare Advantage plans, with some having little to no out-or pocket costs. You can get an estimate of your costs from your plan provider.

Does Medicare cover breast reconstruction surgery after lumpectomy? The Bottom Line

Medicare, both Original and Advantage, will cover your breast reconstruction whether you have had a lumpectomy or a mastectomy. The coverage depends on your plan, but there may be deductibles and coinsurance.

To protect yourself from out of pocket costs related to breast reconstruction after a lumpectomy with Medicare, enter your ZIP code to compare plan options.

 

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