Can I Claim A Medicare Rebate For My Breast Reduction Surgery?
Will Medicare and my Health Insurance Cover my Breast Reduction Surgery?
You may wonder if your private health insurance cover plus Medicare will cover some or all of your Breast Reduction Surgery costs. Breast Reduction Surgery is ONE of the very few breast surgery procedures that your private health insurance and Medicare will cover some or all of your hospital costs, and Medicare will make a small contribution to the medical costs (Surgeon, Anaesthetist, Assistant).
Some patients may even use their Superannuation by way of requesting an early release of funds. Why is that the case?
There are often a number of crucial reasons for wanting Breast Reduction Surgery, including:
- relief from chronic skin infections under the breasts (‘intertrigo’)
- relief from back, neck and shoulder pain caused by the heaviness of the breasts
- rectify other breast-weight related health conditions that affect quality of living, for example going to the gym, and jogging
Will Medicare cover my Breast Reduction?
- Having heavy breasts that cause chronic health conditions constitute a medical reason for having breast reduction surgery.
- If the surgery is deemed by your surgeon to be medically necessary and meets strict Medicare criteria, a rebate should be granted.
- You should first attend your GP to request a referral to a Specialist Breast Surgeon such as Mr Maxwell.
The criterion for a Medicare Claim for Breast Lift Surgery is the age of your youngest child:
- Your youngest child must be at least 12 months (1 year) in age but not older than 7 years of age.
- Breast Reduction surgery is life changing. It can prevent or treat recurring problems related to heavy breasts.
- Most breast reduction patients are happy to find they have a new lease on life –ranging from better sleep to being able to participate in new activities e.g. fitness classes which they have been unable to attend in the past.
Further benefits from Breast Reduction surgery include being able to wear fashionable bras, bathers and other items of clothing you formerly felt weren’t suited to your fuller-breasted appearance.
To be eligible to Claim a Medicare item number for your breast reduction surgery, as with any other Medicare rebate, visit your GP and ask for a referral to Dr Richard Maxwell or phone Cosmetic Surgery For Women on (03) 8849 1462 to find out more about Breast Surgery including Reduction Mammoplasty.
You can also register to attend an EVENT night to learn more about your specific surgery options.
Payment Options for Breast Surgery – Medicare Information & Payment Plan Options
If you’re looking at Medicare rebates, you may be at the funding phase of your surgery decision making process.
To help, this is an excerpt from our Guide To Funding Surgery. It’s a guide that offers helpful information about ways patients choose to pay for their cosmetic or plastic surgery procedures.
Can I Claim Medicare For My Breast Reduction Surgery – Questions & Downloadable Guide
Phone us on (03) 8849 1462 for any questions and to Request a Copy of our E-book that contains information on funding cosmetic surgery including payment plans available from external, independent providers; special savings accounts; and other ways to fund your procedure.
Another way to find out more is to book a consultation with a Surgeon by phoning us directly. You can then register to attend a FREE Monthly Events
Will Medicare cover my Breast Reduction Plastic Surgery?
Reduction Mammoplasty – YES – Medicare Rebates MAY apply – but strict criteria must be met. There is no guarantee, but ask your General Practitioner for information to see if you qualify or speak with a Specialist Plastic Surgeon after getting a referral from your GP.
Why is the Medicare Rebate Question for breast surgery so confusing?
The answer to this question can often be confusing for most patients seeking cosmetic surgery.
- That’s because it will vary depending on the patient and the procedure required.
- Medicare will sometimes offer a minor rebate on some procedures.
- Rebates are generally available only for reconstructive plastic surgery or what is deemed ‘essential’ surgery.
- Not all surgery of the breast falls under this category; but Breast Lift and Breast Reduction MAY fall under this category for many patients.
When it comes to Plastic & Cosmetic Surgery, the Medicare REBATE guidelines are very clear; Medicare will not cover ‘non-therapeutic cosmetic surgery’ NOR ‘non-therapeutic plastic surgery’ procedures. Significant Breast Ptosis after pregnancy and chronic Back Pain or Skin Infections related to large breasts are chronic medical conditions, however, and may lead to eligibility for a minor rebate.
It is important to keep in mind that Medicare Rebates are subject to unpredictable and sudden changes.
- Medicare Codes can suddenly be removed from the rebate schedule.
- So if your procedure is currently eligible for a rebate under Medicare, it may be best to consider having your procedure performed sooner rather than later.
What Plastic Surgery procedures might Medicare cover in relation to eligibility for a rebate?
The answer to this question can also vary, and it depends on the patient’s needs and other health and well-being factors. Medicare may sometimes offer partial rebates on:
- Facial or Nose Reconstructive Plastic Surgery after an accident or trauma
- corrective Rhinoplasty (nasal area reshaping) to rectify an obstructed nasal passage
- corrective Rhinoplasty when your breathing is impaired by a nose injury, deviated septum or other type of
nasal structural abnormality
- Breast reconstruction surgery and breast prosthesis following a Mastectomy or other breast cancer treatments
- Skin ‘tightening’ surgery following rapid weight loss or Bariatric Surgery (surgical excision and reduction of excess skin
and redundant tissues) such as occurs during an Abdominoplasty, Belt Lipectomy or similar procedure
- Bariatric Weight Loss Surgery for Obesity
- Eyelid Lift Surgery where sagging upper eyelid skin impedes vision (medically-necessary Blepharoplasty)
Breast lift or Breast Reduction Surgery (Patients must meet very specific criteria) such as:
- Severe breast ptosis
- Breast Asymmetry
- Other recurring health problems related to the size, position or skin condition of your breast area.
Medicare currently covers ONLY medical and surgical procedures that are clinically NECESSARY for your health.
Medicare won’t cover elective Plastic Surgery or Cosmetic procedures that you choose to pursue for purely cosmetic reasons, such as Liposuction on your thighs.
So if you have sagging, heavy breasts that are causing you health problems, contact your GP and ask for a referral to our highly-regarded Breast Reduction Surgeon, Mr Richard Maxwell. He is also a post-weight loss body contouring expert for skin tightening and body lift surgery.