Will my Health Insurance and Medicare Cover my Breast Reduction Surgery?
Getting a Medicare Rebate for Breast Reduction Surgery is one of a select few breast surgeries that your private health insurance and Medicare will cover. You may be covered for some or all of your hospital costs and Medicare will contribute a small portion to your medical costs; Surgeon, Anaesthetist and Assistant.
Are you considering getting a Breast Reduction? If you are, you may have a lot of questions. You might want to know what your private health insurance cover and/or Medicare will cover. Some patients may also choose to use their Superannuation, which can be achieved by requesting an early release of funds.
Why is there a Medicare rebate for Breast Reduction Surgery?
There are often a number of fundamental reasons people want to get Breast Reduction Surgery, this include, but are not limited to:
- To reduce or eliminate neck, back and shoulder pain that is caused by heavy breasts.
- Relief from chronic skin infections also known as intertrigo occurs under the breasts.
- To correct other breast-weight health conditions that can affect the quality of life. Large breasts can restrict movement and make everyday activities like going to the gym and jogging or playing with your children difficult.
How do I know if Medicare covers my Breast Reduction?
- Your first step should be to request a referral from your GP to see a Specialist Breast Surgeon such as Dr Rebecca Wyten.
- If the surgery is considered medically necessary by your surgeon and if the strict Medicare criterion is met, a rebate should be granted.
- Heavy breasts that cause chronic health conditions, as listed above qualify as medically necessary.
Download Our Medicare and Healthcare Guide
What are the criteria to claim Medicare for a Breast Reduction?
- Your youngest child must be at least 12 months old but not older than 7 years of age.
- Breast Reduction surgery can be life-changing. It can treat or even prevent recurring problems related to having heavy breasts.
- Most breast reduction patients find that the surgery not only makes them happier but gives them a new lease on life. Patients often find that they sleep better and are able to able to partake in activities they could not before their surgery.
- The benefits from Breast Reduction surgery don’t stop there, having large or heavy breasts can also impact on the clothing you can wear and a breast reduction makes finding and wearing fashionable bras, bathers, button-up shirts and other items of clothing much easier and more enjoyable than it was before.
Why is the Medicare Rebate Question for breast surgery so confusing?
The answer to the Medicare rebate question can be daunting and confusing for a lot of people seeking cosmetic surgery. There are many factors that can impact on the answer;
- It is so dependent on the individual patient and the procedure required.
- Not all Breast Surgery falls under this category, however, Breast Lift and Breast Reduction MAY be included for many patients.
- Medicare will on occasion offer a minor rebate on some procedures.
- Rebates are usually only available for reconstructive surgical procedures or surgeries that are considered ‘essential’.
When it comes to Plastic and Cosmetic Surgery, Medicare Rebate guidelines state very clearly that; Medicare will not cover ‘non-therapeutic cosmetic surgery’ or ‘non-therapeutic plastic surgery’ procedures.
However, it also states that significant breast ptosis after pregnancy and chronic Back Pain or Skin Infections related to large breasts are classified as chronic medical conditions and may lead to eligibility for a minor rebate.
Medicare Rebates are subject to unpredictable and sudden changes.
It’s important to remember that Medicare Codes can be removed from the rebate schedule without notice, so if your procedure is currently eligible for a rebate under Medicare you may want to consider having your procedure performed as soon as possible rather than waiting as this may affect your out of pocket cost.
What Plastic Surgery procedures might Medicare cover in relation to eligibility for a rebate?
Unfortunately, this question does not have a straightforward answer as there are many variables. It depends on the patient’s health, well-being and needs. Medicare can sometimes offer partial rebates on:
- Eyelid Lift Surgery where upper eyelid skin droops impeding vision. This is considered medically-necessary Blepharoplasty.
- Reconstructive Plastic Surgery of the Face and/or Nose as a result of an accident or trauma.
- Corrective Rhinoplasty (nasal area reshaping) for the following reasons;
- If breathing is affected as a result of a nose injury.
- Deviated septum
- To rectify an obstructed nasal passage
- Other nasal structural abnormality
- Bariatric Weight Loss Surgery.
- Skin ‘tightening’ surgery following Bariatric Surgery or rapid weight loss
- Breast Reduction or Breast Lift Surgery such as:
- Breast Asymmetry
- Severe breast ptosis
- Recurring health issues caused by the size, position or skin condition of the breast area.
What Medicare Currently Covers
As stated previously in this blog Medicare will only cover medical and surgical procedures that they deemed clinically NESSASSARY for your health. They will NOT cover elective Plastic Surgery or Cosmetic procedures that you opt to have for purely cosmetic reasons, such as Liposuction on your arms or thighs.
If you are currently suffering from large, heavy breast that is impacting your everyday life you may be eligible to Claim a Medicare item number for your breast reduction surgery, visit your GP and ask for a referral to Dr Rebecca Wyten or phone Coco Ruby Plastic Surgery on 1300 264 811 for more information on Breast Surgery including Reduction Mammoplasty.
Payment Options for Breast Surgery
Medicare Information and Payment Plan Options
If you have begun looking into Medicare rebates and your eligibility, you may be at the financial funding phase of your decision-making process.
To assist you in this phase we have provided an excerpt from our Guide To Funding Surgery. This guide contains helpful information about different ways patients can choose to pay for their cosmetic or plastic surgery procedure/s.
If you have any questions please Phone us on 1300 264 811 and request a copy of our e-book. It contains information on funding for cosmetic surgery including what payment plans are available from external, independent providers and special savings accounts as well as other options for funding your procedure.
We also recommend booking a consultation with a Surgeon as this will give you even more information, as well as the opportunity to get all your questions answered directly
Dr Rebecca Wyten’s affiliations and memberships include:
The information we provide is of a general nature.
To find out what to expect for your preferred procedures, arrange to see one of our Specialist Plastic Surgeons for a full-history and surgical consultation. Read more about surgical outcome variability on our Disclaimer page.