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.
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.