Does Medicare Cover Breast Reduction?


Does Medicare Cover Breast Reduction?

Breast reduction is a personal choice that goes beyond cosmetic concerns. You may opt for the procedure to enhance your overall well-being or alleviate physical discomfort, such as back and neck pain. It may help you regain control over your body, addressing both physical and emotional aspects of your health and lifestyle. When considering such a medical intervention, you may wonder, Does my health insurance cover breast reduction?  While health insurance for breast reduction may help you deal with the financial implications, the coverage may not be as straightforward.

Before we dig deeper into the discussion about health insurance that covers breast reduction, let us first factor in the various aspects that may affect the coverage. Understanding the need for breast reduction procedures, the costs and their benefits will help you understand the coverage. Read on.

About Breast Reduction

Contrary to popular belief, breast reduction is not only done to achieve a more proportionate and comfortable body shape. Large breasts can sometimes create health issues for a woman. The weight of the breasts can lead to back, shoulder and/ or neck pain. Apart from this, you may want to consider breast reduction for the following reasons:

  • Cosmetic reasons with the aim of a better body shape
  • Severe back pain
  • The hunch in your posture
  • Headaches
  • Difficulty in breathing, especially when lying down
  • Breast pain
  • Persistent rashes and skin issues

Breast Reduction Surgery

Breast reduction surgery, also called reduction mammoplasty, is an invasive surgery. This means that certain incisions, or cuts, will be required in order to reduce the weight as well as the size of your breasts. Performed under general anaesthesia, the breasts are shaped by removing excess skin, fat and tissues. After the removal, the sutures are closed. The surgery typically takes 2 to 5 hours. However, it depends on the patient. The breast reduction surgery can be conducted in different ways. Depending on your medical condition and your requirements, your surgeon will decide what kind of surgery will suit you the most.

Vertical or Lollipop Surgery

Recommended mostly for a moderate size reduction, in this kind of surgery, an incision is made, starting from the areola to the bottom of your breast. Another circumferential incision is made around the border of the areola.

Inverted-T (“anchor”) Reduction Surgery

In the Inverted-T procedure, along with vertical or lollipop incisions, an additional incision is required. This cut is made along the bottom crease of the breasts. This procedure is more suitable if a more significant reduction is required.


In case you require only a slight reduction, the surgeon may prescribe a liposuction. As it is a less invasive process, it is recommended only when a small amount of fat is to be removed from the breasts.

Breast reduction is a major surgery. It is important that you are well aware of the procedure as well as the recovery. In most cases, patients are discharged the same day, but you will need to take prescribed medicines for a week or so. The recovery time after breast reduction can vary from patient to patient, but everyone needs proper rest to ensure proper healing. For the first few days, your breasts will be bandaged to keep the swelling and bleeding under control. It is common to experience some soreness, pain and swelling after the surgery. While most women resume their everyday activities within a week, you must follow the dos and don’ts given by your surgeon.

Also, you need to manage your expectations post your surgery. Immediately after surgery, there will be some swelling in your breasts. It may take 2 to 3 months for th breasts to heal and start feeling lighter. Usually, it may take up to a year for breasts to soften.

>> Also Read: Know The Different Types of Breast Cancer

Can My Insurance Cover Breast Reduction?

We now come to the question: will medicare cover a breast reduction. A breast reduction surgery can cost from 80,000 to 2.5 lakhs. While these are just an average figure, the exact cost of such a surgery depends on a number of factors. Bearing the cost can be heavy in the pocket, so it is natural to wonder, ‘is breast reduction covered by medicare’.

The answer is both yes and no. confused? Don’t worry, we’ll explain.

Whether breast reduction surgery covered by medicare or not depends on the reason for the surgery. As discussed above, you may be opting for breast reduction either because of a health concern or maybe to enhance your appearance. Let us explore both the scenarios.

1. Will medicare cover breast reduction to improve my appearance?

You need to know that, generally, most health insurance plans do not cover elective cosmetic surgeries. Such surgeries are considered non-essential and are not deemed medically necessary for the individual's health. Therefore, if breast reduction is not a medical treatment and is solely for aesthetic reasons, it is quite possible that your health insurance provider will not cover it.

2. Will medicare cover breast reduction if it is medically essential?

Mist health insurance providers will prioritise the coverage of medically viral procedures rather than the ones that are purely for enhancements of bodily features. There are certain conditions, however, that you have to fulfil in order to be eligible for the coverage.

Care Health Insurance offers a number of health insurance plans, for example Care Supreme, that offer coverage for medically necessary cosmetic surgeries. When the insured individual requires the removal of a direct or immediate risk, the surgery is covered, provided it is certified by a medical practitioner.

Medicare and Breast Reduction: Things to Know

If you are looking for health insurance that covers breast reduction, it is imperative that you confirm the coverage with your insurance provider. Keep the following points in mind. 

  • The coverage under health insurance for breast reduction may differ not only from insurer to insurer but also from plan to plan. Depending on your chosen plan or the sum insured or sub-limits, the coverage that you are eligible for may be different.
  • Approval for medicare and breast reduction might be possible when it is needed for treating some chronic health symptoms. 
  • Your insurance provider may require your doctor/surgeon to submit specific health records that specify the need for breast reduction.
  • You may have to bear the uncovered expenses, co-pay or deductibles as per the chosen plan.

Over to You

Choosing to undergo breast reduction is a significant decision, and it's essential to approach it wisely. Along with the physical and mental implications, you need to keep in mind the financial burden of this surgery. Spend some time to understand the associated risks and benefits and, as far as possible, have realistic expectations.

It is equally important that you understand the coverage of health insurance for breast reduction. Knowing the coverage details beforehand helps individuals make informed decisions and plan for potential out-of-pocket expenses associated with the surgery.

Disclaimers: All plan features, benefits, coverage, and claims underwriting are subject to policy terms and conditions. Kindly refer to the brochure, sales prospectus, and policy documents carefully.

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