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Does Medicare Cover Breast Reduction Surgery?

Christian Worstell by Christian Worstell    |    Published Nov 14, 2019    |    Reviewed by John Krahnert

Medicare covers breast reduction surgery if it is deemed medically necessary by a doctor. If you’re an older woman who is experiencing back or neck pain as a result of your breast size, your breast reduction surgery may be covered by Medicare. Learn more below.

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Understanding Breast Reduction Surgery

The gradual increase in the density of breast tissue (known as breast hypertrophy) can affect your posture and breathing and cause severe back and neck pain. Breast reduction surgery removes excess breast tissue and skin to help eliminate some of these issues. While breast reduction surgery can be costly, Medicare helps cover some of the the costs related to the procedure.

Breast reduction surgery is deemed medically necessary when it seeks to correct either of the following:

  1. Reduce the symptoms caused by hypertrophy, including back pain, neck strain, brassiere grooving, numbness in the hand or arm, rashes, or dermatitis
  2. Reconstruct symmetry after breast cancer surgery

Following surgery, patients will likely feel better and gain more mobility in movement and posture.

How to Qualify for Coverage

For Medicare to cover breast reduction surgery:

  • You must experience symptoms for at least six months
  • Non-surgical medical intervention must have been tested and failed to alleviate the symptoms.

If these conditions are not met, or a physician deems the nature of the surgery as cosmetic and not medically necessary, Medicare will not cover the procedure.

How Much Will You Pay?

If Medicare does cover your breast reduction surgery, you may be responsible for numerous out-of-pocket costs related to the procedure and any subsequent hospitalization, if necessary. These costs can include deductibles, copayments and coinsurance.

 

Medicare Supplement Insurance can help cover your out-of-pocket breast reduction surgery costs.

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