Does Health Insurance Cover Breast Augmentation

People opt for augmentation mammoplasty, also known as breast augmentation, as a voluntary cosmetic surgical procedure to enhance breast size or achieve symmetry.

Understanding the associated costs is crucial, regardless of the motivations driving your interest in augmentation mammoplasty.

Various factors contribute to a surgeon’s pricing, including their experience, the chosen augmentation type, and the geographical location of the procedure.

Many patients often inquire about the possibility of insurance coverage for breast augmentation.

The American Society of Plastic Surgeons asserts that, in general, most health insurance plans do not cover expenses, complications, or revision surgery related to cosmetic breast augmentation.

However, there are cases where insurance coverage may be applicable.

If your procedure is classified as reconstructive rather than cosmetic, there is a possibility that it could be eligible for insurance coverage.

Does health insurance cover breast augmentation
Breast augmentation surgery is generally considered an elective cosmetic procedure and is not covered by most health insurance plans: Photo courtesy (Healthline)

When Does Insurance Cover Breast Augmentation?

Cosmetic breast augmentation rarely gets insurance coverage.

Mastectomy patients due to cancer may receive partial insurance coverage for the procedure.

How Much Does Breast Augmentation Cost?

The usual cost hovers around $6,550, encompassing fees for the surgeon, operating room, and anesthesia.

Cosmetic cases are generally not covered by insurance, necessitating patients to handle the entire expense independently.

Surgeons may suggest payment plans for surgeries scheduled in advance, providing an option for discussion during the booking process.

COSMETIC BREAST AUGMENTATION

Cosmetic procedures encompass a range of enhancements aimed at improving one’s aesthetic appeal.

Take, for example, breast augmentation, which falls within the realm of cosmetic surgery when the goal is to enhance your appearance in a swimsuit.

Other instances of cosmetic interventions include rhinoplasties, which reduce nose size, as well as implants in areas like the chest or calf, and facial rejuvenation treatments such as facelifts.

Various legitimate reasons may motivate your consideration of these surgical options, providing you with a diverse array of choices.

It’s important to note, however, that if insurance does not deem these procedures medically necessary, they will not cover the costs.

RECONSTRUCTIVE BREAST AUGMENTATION

Insurance usually covers breast reconstructive surgery if medical necessity is determined.

The extent of coverage depends on both the specific procedure and your insurance policy.

Reconstructive surgery aims to address functional issues and correct deformities.

For example, insurance providers commonly cover augmentation mammoplasty following mastectomy, particularly in cases of breast cancer, as they view it as a reconstructive procedure.

EVOLVING DEFINITIONS

The meanings of cosmetic and reconstructive terms are always changing.

“Deformity” now includes not just rebuilding post-mastectomy breasts but also matching the other breast’s appearance.

Post-reconstruction, women can get coverage for elective aesthetic revision surgery, like changing surgical methods or updating implants.

Remember, patients must collaborate with their insurer.

Some cover breast implant revisions up to eight years post-reconstruction, others for a shorter time.

Leave a Comment