Does Medicare cover breast reduction surgery?

There are a number of reasons why a person may need breast reduction surgery. Large breasts can affect your daily life and cause chronic medical conditions like:

• Back, shoulder, and neck pain

• Postural changes

• Skin infections

• General body soreness or pain

Medicare covers breast reduction surgery if it is medically necessary to treat conditions that stem from larger breasts. Medicare, however, will not pay for the procedure if it is purely for cosmetic reasons. 

Key takeaways:

• Medicare only covers breast reduction surgery if it is medically necessary to treat a condition. 

• If it’s not covered by Medicare, breast reconstruction surgery could cost somewhere between $9,000 and $20,000.

What is breast reduction surgery?

Breast reduction surgery, or reduction mammoplasty, is a procedure that reduces the size of the breast by removing fat, tissue, and skin. Once a surgeon removes excess breast tissue, fat, and skin, they reshape the remaining breast tissue to make the appearance natural.

You typically need breast reduction surgery to relieve discomfort and health conditions caused by having large breasts. Some people may also choose to get breast reduction surgery for cosmetic reasons.  

Breast reduction surgery starts with a consultation with a doctor or surgeon. The two of you discuss your medical history and how much you should reduce your breast size. If you’re considering breast reduction surgery to treat or reduce the symptoms of another condition, your doctor will also determine if the procedure is medically necessary.

Does Medicare pay for breast reduction surgery?

Medicare will only cover breast reduction surgery if it’s medically necessary to treat a condition caused by having large breasts. In general, Medicare won’t pay for any cosmetic procedures unless there’s an underlying medical reason. 

Before getting the surgery, your doctor will assess your medical history, how long you’ve been experiencing health issues related to having large breasts, and whether or not other treatment options would work better for your case. 

Your health provider may also consider:

• Your family’s  history with breast cancer

• Future pregnancy plans

• Your ability to breastfeed 

If it’s medically necessary for you to have breast reduction surgery, Medicare covers any post-operative care like a post-surgical bra to make the healing process easier. 

Medicare also covers breast reconstruction surgery if a person needs a mastectomy (surgery to remove a breast) because of breast cancer. 

How much does breast reduction surgery cost?

Breast reduction surgery is expensive if you have to pay for it out of pocket. You can expect to pay between $7,000 to $10,000 for breast reduction surgery.

Other cosmetic surgeries Medicare covers if medically necessary

Medicare covers a few other cosmetic procedures if the surgery is medically necessary to treat a health problem. Keep in mind that doctors often prescribe these procedures for medical purposes even if they can be cosmetic in some situations. 

These surgeries include:

• Blepharoplasty: Surgery on your eyelid to remove excess tissue

• Botox injections: Injections used to treat muscle disorders, like spasms and twitches

• Panniculectomy: Surgery to remove excess skin and tissue from your lower abdomen

• Rhinoplasty: Surgery to change the shape of your nose

• Vein ablation: Surgery to close off veins

It’s important to note that Medicare requires prior authorization to cover these services and procedures to make sure that these procedures are medically necessary and not just for cosmetic purposes. 

Understanding your Medicare coverage

Medicare coverage is complex and every person’s situation and coverage is unique. Take care of your health and save money by talking to a licensed Medicare Advisor who can help you understand every part of your plan and change plans if necessary. Call 855-900-2427 or schedule a chat today to get your Medicare questions answered.