Does Medicare Cover Breast Implant Removal? 

Breast augmentation surgery is one of the most common types of cosmetic surgery in the United States today. While many women undergo this procedure to enhance their appearance, thousands of women choose to get breast implants after a mastectomy to reconstruct the shape of their breasts after surgical removal. 

Both types of breast implants – saline and silicone – come with some health risks that can include leaking, rupturing, infection, scar tissue buildup, breast pain, an autoimmune response, calcium deposit buildup, tissue necrosis, capsular contracture, or movement of the breast implant. 

If any of these conditions happen to you, you might need to have your breast implant(s) surgically removed, and your Medicare insurance may help you cover some of the costs.

Does Medicare cover breast implant removal? 

Medicare doesn’t typically cover health care services unless they are certified as medically necessary, so your coverage depends on the reason for breast implant removal surgery. 

Medicare may help you pay for your breast implant removal surgery if your health care provider diagnoses any of the following conditions:

• A breast prosthetic has ruptured, is leaking, has failed, or if there’s a bump or bulge that isn’t normal. 
• The prosthetic is responsible for an infection or an inflammatory reaction. 
• The breast implant is responsible for a health issue such as siliconoma, granuloma, or capsular contracture, which is causing pain or a deformity. 
• Your breast prosthesis is an obstruction to a breast cancer diagnosis. 
• If you’ve had your implant for more than 10 years, your health care provider may feel it’s medically necessary to have it removed for the sake of good health. 

You may also be eligible for breast implant removal surgery even if you got the implants for cosmetic reasons, and the procedure wasn’t covered initially by Medicare if you are experiencing any of the qualifying conditions listed above.  

Finally, Medicare covers all stages of breast reconstruction surgery and health care if you’ve had it after a mastectomy because of breast cancer. If your physician orders your breast implant(s) to be removed for medically necessary reasons, Medicare covers the procedure. 

If you’re enrolled in Original Medicare Parts A (hospital insurance) and B (medical insurance) , the part that covers your breast implant removal surgery depends on where you have the procedure done. 

Medicare Part A covers you if you have surgery as an inpatient in a hospital that accepts Medicare assignment. Your coverage begins after you pay the deductible for the benefit period. You may also be charged a daily coinsurance amount if you are an inpatient for more than 60 days. 

Medicare Part B covers your breast implant removal procedure if you are an outpatient in a Medicare-participating hospital, outpatient clinic, or other medical facility, and if the surgeon accepts Medicare assignment. Part B pays 80 percent of the final approved cost after you meet your annual deductible, and you pay the remaining 20 percent. 

Does Medicare Advantage cover breast implant removal?

If you’re enrolled in a Medicare Advantage (MA) plan, your provider is obligated to cover the same benefits as Original Medicare Parts A and B if you meet all eligibility requirements. 

Some Medicare Advantage plans require beneficiaries to use network-approved health care providers, hospitals, outpatient clinics, and other providers. Depending on your plan, you might not have coverage if you use providers outside the network, so make sure you know the details of your plan before making health care arrangements. 

How much does breast implant removal surgery cost without Medicare coverage? 

Across the United States, breast implant removal surgery costs an average of $3440 without anesthesia, operating room charges, and other related expenses, but it can vary according to where you have it done and who performs it. 

If you don’t have Medicare coverage, you should consider the following costs for breast implant removal surgery:

• The surgeon’s fee
• Hospital or medical facility charges
• Anesthesia and anesthesiologist’s fees
• Prescription medications
• Post-surgery garments
• Medical tests, lab tests, X-rays, etc. 

The medical facility you choose for your surgery should provide detailed information regarding all costs involved with your procedure before you go ahead with the procedure.