Will Medicare cover breast reconstruction after a double mastectomy?

I had a double mastectomy, followed by XRT around 4 years ago. I had a lot going on during this time so I chose to push any breast reconstruction to the side. Obviously this is a very expensive procedure, will my insurance cover the bill for breast reconstruction? Does it matter that it has been 4 years?


F, 55, California

Tags:woman insurance mastectomy

At 47 I was diagnosed with breast cancer. Being diagnosed with cancer was one of the worst moments of my life. A lot went through my mind, getting healthy, breast reconstruction, and the cost of medical care. I was worried about Medicare covering the cost of my reconstruction surgery. My doctor informed me that insurance companies were required to cover the costs of reconstruction surgery. The only caveat with Medicare covering the costs was the medical necessity of the mastectomy. My double mastectomy was the result of cancer, so the costs of reconstructive plastic surgery would be covered by Medicare. Hearing this news help to lessen my concerns about whether or not I could undergo reconstruction surgery.

Luckily, Medicare does cover breast reconstruction after a medically necessary mastectomy. I wouldn't have been able to afford the procedure without this healthcare. Because my breasts were not going to be symmetrical, the other breast was corrected to create symmetry. This procedure was also covered by Medicare. I could not be happier. I am healthy and feel confident due to having reconstructed breasts.

I had my breast reconstruction done directly after I finished up with radiation from breast cancer so I had to look into your particular question. First of all, apparently every health insurance that covers mastectomy is also required to cover reconstructive surgery, so no matter which insurance you have you should be covered.

I also found that Medicare specifically will definitely cover your breast reconstruction regardless of how long it has been since your mastectomy. I did find that you can run into some smaller issues about the reconstructive type (depending on insurance company) and everything so you should definitely talk to your doctor first.

But, in short, you will be able to get breast reconstruction surgery with your Medicare-coverage without any issues. If you are worried about it you should talk with them to make sure that you choosing a provider that is covered before you move forward. I hope that helps!

I have Medicare, and I waited two years after my mastectomy to get breast reconstruction. Medicare covered my reconstruction, and I didn’t have any problems getting them to cover my reconstruction surgery. I read about a law that states health insurance providers must pay for mastectomies and associated reconstructive surgeries. So, even if you wait 10 years to get your breast reconstructive surgery, Medicare will still pay because it is associated with your mastectomy. I suggest you ask your insurance company if your type of procedure is covered under your insurance plan--especially if it’s a new type of breast reconstructive surgery. Some insurance companies may hassle you about getting new or experimental types of breast reconstructive surgery instead of conventional ones. Also, my friend had an issue with her Medicare provider when they refused to cover her out-of-network breast surgeon. So, just remember to ask which types of breast reconstruction surgeries are covered and the costs you’ll incur if you stay in-network or choose an out-of-network provider.

I have Medicare, and I had a double mastectomy. Medicare does cover breast reconstruction. In fact, the Women's Health and Cancer Rights Act in 1998 and the more recent Breast Cancer Patient Education Act protect the rights of women and ensure that insurance companies cover breast reconstruction for women that have mastectomies. I believe that your breast reconstruction will still be covered by Medicare even four years after your mastectomy if you currently still have Medicare coverage. You should check with your plastic surgeon and contact Medicaid to find out specific instructions. My journey was difficult, but now I am enjoying health and my new breast implants. I wish you the best of luck.