Insurance Coverage for Reconstructive Surgery

Medicare & Medicaid

Medicare is health insurance provided by the federal government to people who are 65 years of age or older, on renal dialysis or permanently disabled. Medicare covers breast reconstruction after a mastectomy.
Medi-Cal provides health care to people who have a low-income. This program is run jointly by the federal and state governments, so benefits and eligibility (who can join) vary from state to state. Many states require all health insurance providers (including Medi-Cal) to cover breast reconstruction after a mastectomy.

Women's Health and Cancer Rights Act of 1998

The Women's Health and Cancer Rights Act of 1998 requires group health plans, insurance companies and health maintenance organizations (HMOs) that pay for mastectomy to also pay for:

  • Reconstruction of the breast removed with mastectomy
  • Surgery and reconstruction of the opposite breast to get a symmetrical look
  • Breast prostheses
  • Treatment of any complications of surgery, including lymphedema

The Women’s Health and Cancer Rights Act does not apply to some church and government insurance plans. For more information on the Women's Health and Cancer Rights Act, visit the Department of Labor website or call toll-free at (866) 275-7922.

State Laws

Many states require all health insurance providers (including those not covered under the Women’s Health and Cancer Rights Act) to pay for reconstructive surgery after a mastectomy. Check with your state insurance commissioner's office or your health insurance provider to find out which services are covered by your state's laws and your health plan.
For more information on insurance coverage of breast cancer-related services by state, visit the American Society of Plastic Surgeons' website.

Our Accolades