Sunday, April 7, 2024

Will Medicare Pay For Breast Augmentation

Don't Miss

Medicare Advantage Plans Cover Breast Cancer Treatments And Screenings

How to get breast Augmentation/Reconstruction on Medicare (Revised)

Medicare Advantage plans are required to offer all of the same benefits that are covered by Original Medicare, combined into a single plan.

This means that the breast cancer screenings, treatments and drugs listed above are covered by Medicare Advantage plans in the same way that they are covered by Medicare Part A and Part B.

Some Medicare Advantage plans may also offer coverage for potentially more breast cancer drug costs than what Original Medicare covers.

Two out of every three cases of invasive breast cancer occur in women over the age of 55.1 And breast cancer accounts for the second-highest number of cancer-related deaths for U.S. women, behind only lung cancer.2

Dont let your breast cancer screenings and treatment go without adequate medical attention and insurance coverage.

If you want to learn more about how a Medicare Advantage plan could help offer the benefits you need, call to speak with a licensed insurance agent today or compare plans online, with no obligation to enroll.

Find Medicare Advantage plans in your area

Or call 1-800-557-6059TTY Users: 711 to speak with a licensed insurance agent. We accept calls 24/7!

About the author

Christian Worstell is a licensed insurance agent and a Senior Staff Writer for He is passionate about helping people navigate the complexities of Medicare and understand their coverage options.

Where you’ve seen coverage of Christian’s research and reports:

The Above Policy Is Based On The Following References:

  • Alster T. Laser scar revision: Comparison study of 585-nm pulsed dye laser with and without intralesional corticosteroids. Dermatol Surg. 2003 29:25-29.
  • Amaral MJ. Plastic surgery or esthetic surgery? Acta Med Port. 1998 11:97-99.
  • American College of Obstetricians and Gynecologists . Vaginal ‘rejuvenation’ and cosmetic vaginal procedures. ACOG Committee Opinion No. 378. Washington, DC: ACOG September 2007.
  • Atiyeh B, Costagliola M, Illouz YG, et al. Functional and therapeutic indications of liposuction: Personal experience and review of the literature. Ann Plast Surg. 2015 75:231-245.
  • Atiyeh BS, Ibrahim AE, Dibo SA. Cosmetic mesotherapy: Between scientific evidence, science fiction, and lucrative business. Aesthetic Plast Surg. 2008 32:842-849.
  • Balk EM, Earley A, Avendano EA, Raman G. Long-Term Health Outcomes in Women With Silicone Gel Breast Implants: A Systematic Review. Ann Intern Med. 2016 164:164-175.
  • Ball CM. Laser treatment of unwanted hair. Bazian Ltd., eds. London, UK: Wessex Institute for Health Research and Development, University of Southampton 2003.
  • Banikarim C, De Silva NK. Overview of breast disorders in children and adolescents. UpToDate . Waltham, MA: UpToDate reviewed November 2012.
  • Beljaards RC, de Roos KP, Bruins FG. NewFill for skin augmentation: A new filler or failure? Dermatol Surg. 2005 31:772-776 discussion 776.
  • Endo Aesthetics LLC. Qwo for injection, for subcutaneous use. Prescribing Information. Malvern, PA: Endo revised July 2020.
  • Private Insurers Cover More

    The research was presented at the 2011 San Antonio Breast Cancer Symposium. Among the findings:

    • Overall, 42% of women younger than 50 and 17% of women 50 and older underwent immediate reconstruction over the 10 year period.
    • The percentage of women opting for immediate reconstruction increased steadily from 15% in 2000 to 33% in 2010.The largest increase came from women under 50 and women with private insurance .
    • Women with very early breast cancer known as ductal carcinoma in situ, or DCIS, were more likely to undergo immediate reconstruction than those with cancers that had invaded the breast.

    Women with private insurance are more likely to have a greater portion of the cost covered, says Patricia Ganz, MD, director of prevention and control research at UCLA Jonsson Comprehensive Cancer Center.

    While the price tag of mastectomy remained stable over the decade, the cost of immediate reconstruction tripled, Hershman says. The hospital stay for mastectomy plus the plastic surgery runs about $15,000 if a woman opts for implants and $17,000 if breasts are rebuilt using tissue from her body, she says.

    Not everyone wants or should have . But there should be universal access regardless of type of insurance, Hershman says.

    These findings were presented at a medical conference. They should be considered preliminary as they have not yet undergone the peer review process, in which outside experts scrutinize the data prior to publication in a medical journal.

    Also Check: Does Medicare Cover Erectile Dysfunction Pumps

    Will Medicare Cover Breast Lift Surgery For Medical Reasons Mbs Criteria

    Breast surgery may be warranted for medical reasons as well as potential improvements in your well-being.

    To be eligible for a Medicare rebate the surgery will need to be deemed medically necessary by meeting these strict Medicare criteria. Not all patients will meet these criteria:

  • Your GP or plastic surgeon will need to assess the degree of breast ptosis the nipple must be significantly beneath the inframammary fold and photographic evidence is required
  • Another strict criteria is that IF you have been pregnant your youngest child must be between the ages of 1 year and 7 years old at the time of surgery. If you have not been pregnant this does not apply.
  • You will need to get and hold a current medical referral at the time of surgery A Referral from a GP lasts 12 months and a referral from a specialist lasts 3 months.
  • Find out about the medicare criteria for breast reduction surgery on our blog page.

    When Will Medicare Cover Plastic Surgery

    Breast Reduction &  Medicare

    Plastic surgery and cosmetic surgery are often used interchangeably. However, there are some fundamental differences between the two types of surgeries.

    Reconstructive plastic surgery is used to repair areas of the body that may be affected by trauma, disease, or developmental defects. Cosmetic plastic surgery is a type of plastic surgery that is used to enhance the natural features of the body.

    Due to the distinctions between these two types of surgeries, there are differences in the education, training, and certification of plastic and cosmetic surgeons:

    • Plastic surgeons are certified by the American Board of Plastic Surgery. After medical school, they must undergo at least six years of surgical training and three years of residency training. They must pass a series of exams and take part in continuing education programs each year. Board-certified plastic surgeons only perform surgery in accredited or licensed facilities.
    • Cosmetic surgeons must have at least four years of residency experience to become certified by the American Board of Medical Specialties. After this, they can choose to become certified by the American Board of Cosmetic Surgery. However, this is not a requirement.

    Many board-certified plastic surgeons also practice cosmetic surgery. To practice both, plastics surgeons must have additional training in cosmetic surgery.

    If you are enrolled in Medicare, there are three primary situations when Medicare will cover your plastic surgery.

    Don’t Miss: Does Medicare Cover Lung Cancer Treatment

    Facial Palsy & Facial Nerve Surgery Medicare Item Numbers

    • 11018 NEUROMUSCULAR ELECTRODIAGNOSIS conduction studies on 4 or more nerves with or without electromyography OR recordings from single fibres of nerves and muscles OR both of these examinations
    • 39330 NEUROLYSIS by open operation without transposition, not being a service associated with a service to which item 39312 applies
    • 45588 Meloplasty , bilateral, if: surgery is indicated to correct a functional impairment due to a congenital condition, disease or trauma and photographic and/or diagnostic imaging evidence demonstrating the clinical need for this service is documented in the patient notes

    What Is Not Covered

    Medicare does not cover any cosmetic surgery procedures. This means that if your procedure is elective and for appearance only, youll pay 100 percent of the costs.

    This is true no matter what kind of Medicare plan you have. Neither Advantage plans nor Medigap plans offer additional coverage for cosmetic procedures.

    You May Like: How To Qualify For Oxygen With Medicare

    Also Check: When Do Medicare Premiums Increase

    Does Medicare Have Coverage For Plastic Surgery

    Coverage for plastic surgery for treatment or repair is likely. This can include repair after an accident or for the treatment of severe burns. Some therapeutic surgeries that serve a cosmetic change may be allowable.

    Lets say Sally has breast implants that prevent breast cancer treatment. Well, Part A can help with costs in an inpatient setting. If the procedure is done in an outpatient setting, Part B covers 80% of the costs. For the lowest cost, go to a doctor that takes Medicare.

    Will Medicare Cover My Surgery

    Medicare & You: National Breast Cancer Awareness Month (NBCAM)

    If you have a valid medical referral and meet the strict criteria for a Medicare item number, then you may get a Medicare rebate and could be eligible for a subsidy from your Private Health Insurance fund.

    Medicare will NOT cover purely cosmetic surgery but some breast, body, nose and face surgery is regarded as medically necessary and you can qualify for a rebate if you have a valid medical reason.

    Recommended Reading: Where To Get Medicare Information

    So What Is A Valid Medical Reason For Plastic Surgery

    A valid medical reason for surgery can include things like:

    • Facial reconstructive surgery after an accident or trauma
    • Nose Surgery to rectify an obstructed nasal passage or breathing issue
    • Breast reconstruction following a mastectomy or removal/replacement of an implant
    • Breast Surgery for overly large or sagging breasts
    • Post Weight Loss Surgery following massive weight loss
    • Plastic surgery following skin cancer removal, cancer or some minor skin surgery

    For other surgical procedures, the best way to find out if you will be covered by Medicare is to consult a qualified medical professional or specialist surgeon.

    Does Health Insurance Cover A Breast Lift

    Breast lift is a primarily cosmetic surgical procedure but in certain cases, it may be medically needed, in such cases Medicare and Health insurance may cover part of your breast lift procedure. You will need to fulfil various criteria before being eligible for this Medicare funding of your breast lift. Your private health insurance will not cover elective breast lift surgery done for purely cosmetic purposes. In addition to Medicare funding, some Superannuation funds may provide coverage for the surgery under specific conditions.

    You May Like: Does Medicare Pay For Anesthesia

    Does Medicare Advantage Cover Plastic Surgery

    Medicare Advantage plans have various rules in each area, talk to the company about plan costs. Cosmetic surgery doesnt have coverage because its for image gains. However, plastic surgery fixes damage or disease.

    Advantage plans must pay at least as well as Medicare. So, if you receive a denial, file an appeal through the advantage plan. Although, without medical proof, nobody will cover.

    When Does Medicare Pay For Plastic Surgery

    breast augmentation surgery in the operating room surgeon tools implant ...

    Medicare may cover plastic surgery if it is a reconstructive procedure performed on an area of the body that is malformed or damaged due to injury or an operation. The goal of the cosmetic surgery is to restore a normal appearance and/or function.

    Plastic surgery is typically only covered by Medicare if it is for an approved condition, such as:

    • Breast reconstruction following mastectomyBreast reconstruction and external breast prostheses are typically considered eligible for Medicare coverage following cancer treatment.
    • Accidental injuryAccidental injuries that have caused trauma or damage to a body part may be approved for plastic surgery covered by Medicare.For example, if you are in a car accident and suffer damage to your eye, Medicare may cover necessary plastic surgery to restore the appearance and function of the affected eye.
    • MalformationPlastic surgery to fix malformed body parts may be covered by Medicare if they are deemed medically necessary by your doctor.

    Medicare does not provide any coverage for selective plastic surgery. You will have to pay 100% of the costs out of pocket for selective comsetic surgeries, such as:

    • Breast enlargement
    • Rhinoplasty

    Read Also: Can You Use Medicare In Any State

    Can I Claim My Breast Implant Removal On Medicare

    Patients interested in Breast Implant Removal often send us inquiries regarding the coverage of this procedure by Medicare and other health insurance providers. Unfortunately, there is no straightforward answer to this question, at least not one that would apply to all patients. In order for Medicare to cover the cost of the Breast Implants Removal procedure, there are certain conditions that must be met.

    Will Medicare Pay To Remove My Breast Implants

    Medicare usually covers breast implant removal for any of these conditions:

    • Painful capsular contracture with disfigurement
    • Implant rupture
    • Implant extrusion
    • Interference with the diagnosis of breast cancer
    • Siliconoma or granuloma

    Medicare coverage can differ depending on the state where you live. You can check the specific Medicare policies on breast implants removal in your state here.

    Whether or not Medicare will pay for your breast implant removal depends on many factors. Below are some questions that will help you figure this out.

    Recommended Reading: Do I Have To Pay For Medicare On Ssdi

    How Breast Enlargement Surgery Works

    Your consultant will explain the different implants available and the pros and cons of each.

    Types of implants

    • May be less likely to harden than silicone
    • Feel less natural than both types of silicone
    • More prone to wrinkling than silicone
    • More likely to rupture or deflate than silicone but if they do rupture, theyll safely pass out of the body
    • Inserted while still empty and then filled with sterile salt water once theyre positioned correctly


    Breast implants are measured by volume and not bra size. Your consultant can help you choose the most suitable implant size for you based on:

    • The size of your rib cage
    • Your existing volume of breast tissue

    Shape and projection

    • Teardrop shape you can choose the height and width separately, so theres more control over the shape
    • Round shape theres a bigger volume at the top
    • Projection you can choose how much the implant sticks out to give a subtle or a more obvious look

    The surgery: what happens?

    The operation will be performed by your surgeon under general anaesthetic, so youll be asleep. Once youre asleep, your surgeon will make an incision either:

    Your surgeon will then create a pocket inside the breast for the implant by separating your breast tissue from the muscles and connective tissue in your chest. Theyll then insert the implant through the cut, positioning it as agreed. Implants can be placed:

    To find out more about how breast enlargement is carried out at your local Spire hospital, find your nearest hospital.

    What Are The Risks Of Breast Augmentation

    Breast Reduction: What Patients Should Know Part 3

    Like any surgery, breast implant surgery comes with risks. You should discuss the risks in detail with your surgeon.

    You should also discuss the risks of anaesthetic with your anaesthetist. Some of the more common problems that occur in at least 1 in 100 women include:

    • bleeding, or a collection of blood
    • infection
    • changes to sensation of the breast skin or nipple, including numbness
    • swelling or collection of fluid around the breast
    • injury to surrounding tissue

    There are other rare but serious risks to consider including:

    • an allergic reaction to the anaesthetic
    • blood clots in the legs, which can travel to the lungs and cause serious illness

    Some women find that after surgery their breasts do not look how they had hoped. Sometimes, breasts can be uneven, dimpled, hardened or feel lumpy. Sometimes, the nipples are uneven and this can cause problems.

    The implants can also make it harder to detect breast cancer during screening checks. Some women with breast implants can breastfeed after surgery, but others cannot.

    You should consider that you may need another operation. The younger you are, or the longer you have breast implants, the more likely you are to eventually have problems. And if you have them removed but not replaced, your breasts might be scarred and dimpled.

    Recommended Reading: Does Medicare Cover Walking Canes

    Pros And Cons Of Breast Ultrasound

    When there are questions about a mammogram finding or a mammogram cannot be performed, a doctor may recommend a breast ultrasound to get more information.

    A breast ultrasound is a relatively low-cost test that uses sound waves to generate an image of the breasts. It is hard to detect small abnormalities like breast calcifications on ultrasound, but it can be a helpful test for people with cysts, masses, and breast implants.

    Using a mammogram and breast ultrasound together improves the detection of breast cancer in people with dense breasts. One study shows that sensitivity increased from 74% with mammogram alone to 96% when both studies were used.

    More breast cancers are detected thanks to breast ultrasound. Case in point, states with dense breast notification laws have seen an increase in the number of ultrasounds performed and the number of cancers diagnosed.

    These laws require a letter be sent to anyone whose mammogram shows dense breast tissue, even if their mammogram was otherwise normal, to let them know about their increased risk for cancer.

    Unfortunately, breast ultrasounds increase false positive results too. This means that people who do not have cancer could be told they might have it. This can lead to unnecessary worry and testing.

    Can You Pay For Breast Implants With An Hsa

    Are you wondering if you can pay for breast implants with a health savings account , flexible spending account , or health reimbursement arrangement ? You may also be wondering if this item is eligible or ineligible for reimbursement with your HSA, FSA, or HRA.

    No, unfortunately you can’t use your HSA, FSA, or HRA to pay for breast implants. In fact, if you do pay for breast implants with one of those accounts, you may be subject to a penalty.

    Recommended Reading: Why Do Doctors Hate Medicare Advantage Plans

    What To Expect Before And After Surgery

    A mastectomy is a major surgery that will require preparation, at least several days in the hospital, and an extensive recovery process. The type of cancer you have may also require systemic treatments or radiation therapy. Even prophylactic surgeries have long-term impact, both physically and emotionally.

    How Do I Prepare For A Breast Augmentation

    Sample Letters of Medical Necessity for Insurance Coverage of ...

    If you decide to go ahead, get as much information about the procedure as possible and know what results you can expect.

    If you smoke, try to quit, as smoking slows down your recovery. You should also check with your doctor if you need to make any changes to any medication you are taking. It is also important to be as fit as possible to help the recovery process.

    Read Also: How Often Will Medicare Pay For A Pap Smear

    More articles

    Popular Articles