Does Medicare cover breast reduction?

Does Medicare cover breast reduction surgery? Medicare will generally cover surgery if it is considered medically necessary. Medicare will not cover cosmetic surgery. Learn more about Medicare coverage for reduction mammoplasty below, then use our quote tool to compare rates to make sure you are getting the best coverage for you.

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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 is the federal health insurance program for people 65 or older, certain younger people with disabilities, and people with end-stage renal disease.
  • Medicare will generally cover breast reduction surgery if it is considered medically necessary.
  • Medicare will not cover elective cosmetic surgery.

There are many reasons you may need to get breast reduction surgery. Oversized breasts can be uncomfortable and can lead to many problems associated with the head, neck, shoulders, and back, adversely affecting your posture. Or perhaps you recently underwent a mastectomy and need to reconstruct your breasts to improve their symmetry.

Whatever the case may be, breast reduction surgery can be awfully expensive if you don’t have health insurance. If you’re 65 or older or otherwise qualify for Medicare, you may be wondering: Does Medicare cover breast reduction?

Fortunately, you’ve come to the right place. In this article, we’ll be answering the question of whether Medicare covers breast reduction surgery and how to determine if you qualify for coverage.

Keep reading to learn more. If you’re looking for affordable health insurance, enter your ZIP code into our free comparison tool above and get quotes from affordable providers in your area today.

Does Medicare cover breast reduction surgery?

Generally, Medicare will only cover breast reduction surgery (also known as reduction mammoplasty) if it is considered medically necessary.

This means if your breasts are affecting your posture and causing you pain in your head, neck, shoulders, or back, then your breast reduction surgery would be considered medically necessary and would be covered by Medicare.

Also, if you have recently had a masectomy due to breast cancer and want to reconstruct your breasts to improve their symmetry, you would also be covered under Medicare.

However, keep in mind that Medicare does not cover elective cosmetic surgery. If you are looking to get breast reduction surgery to improve your self-esteem or because you are unhappy with your appearance, your surgery will not be covered by Medicare. You will have to pay 100 percent of the costs out of pocket. That could cost you over $5,000.

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How do I qualify for coverage?

If chronic pain is the reason you are seeking breast reduction surgery, you will have to meet a few more conditions before you can qualify for Medicare coverage for your reduction mammoplasty. Your doctor will need to verify:

  • That breast reduction surgery is necessary in order to alleviate your pain.
  • That other nonsurgical procedures have not worked in treating your pain.
  • That your symptoms have persisted for at least six months.

If your doctor verifies these three conditions, you should qualify for Medicare coverage of your breast reduction surgery.

However, keep in mind that you will have to get your breast reduction surgery done at a place that accepts Medicare coverage, as not all places do. If you have Medicare Advantage, you might also need to make sure the surgeon and the facility are in your network or you could risk losing coverage.

If you have recently undergone a mastectomy and are looking for breast prostheses, you may also qualify for Medicare coverage for breast prostheses.

Now that you know Medicare covers medically-necessary reduction mammoplasty, use our free comparison tool to find affordable health insurance coverage in your area. Simply enter your ZIP code below to get started.

 

 

 

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