Does Medicaid cover the costs of a breast reduction?

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I wear a 42 DD bra size. As I've been working out and losing weight (going from 265 to 230 pounds), it has become increasingly difficult to continue exercising due to constant back pain, neck pain, headaches, and shoulder pain. Wearing bras or sports bras often leads to tearing and burning along my breast line. I'm wondering if Medicaid will cover a breast reduction surgery to help alleviate these issues.

Asked by MysticalEssence
2017-10-26 00:52:48

3 Answers

Answer

Answered by George Yang, MD, 15/08/2023 08:04

Thank you for your question. Based on your description, you may be an excellent candidate for breast reduction surgery, which tends to yield highly satisfying results. While Medicaid (and Medicare) has been known to cover breast reduction surgery, most plastic surgeons do not work with these insurance providers for various reasons. Finding a reputable plastic surgeon who accepts Medicaid may pose a challenge. When it comes to the outcome of breast reduction surgery, the most critical decision you can make is selecting a skilled and experienced plastic surgeon. I recommend starting with the American Society of Plastic Surgery and/or the Aesthetic Society of Plastic Surgery to obtain a list of well-regarded, board-certified plastic surgeons. Arrange consultations with a few surgeons who specialize in aesthetic surgery. Request to see extensive examples of their work and, if possible, speak with or see patients who have undergone similar procedures. I hope this information, along with the attached link, is helpful. Best wishes.
Answered by Mehryar Taban, MD, 15/08/2023 08:04

Yes, Medicaid does cover breast reductions. However, the challenge lies in finding a board-certified plastic surgeon who accepts Medicaid's low reimbursement rate as full payment. Additionally, many hospitals do not accept Medicaid. Therefore, you may want to consider seeking a residency program in plastic surgery to have your surgery performed.
Answered by Jason Emer, MD, 15/08/2023 08:04

Medicaid may require you to try alternative treatments such as weight loss and physical therapy before approving breast reduction surgery. Providing records from your family practice or internal medicine physician documenting your pain in the neck, back, and shoulders over the years can help with the Medicaid preauthorization process. Insurance companies typically require a reduction of 500 grams (equivalent to 3 cup sizes) from each breast. It's worth noting that some plastic surgeons may not be able to cover the costs of the surgery due to Medicaid's low reimbursement rates. Residency clinics in university settings with plastic surgery training programs may offer reduced fees. - Kenneth Hughes, MD

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