Will Insurance and Medicare Cover Breast Augmentation?

• 8 December 2022
• MCC Marketing

Last updated on December 8, 2022

When it comes to getting implants to enhance your bust, one of the biggest questions people have is whether their insurance or Medicare will cover the breast enhancement procedure. In this blog post, we’ll take a look at whether or not private health funds and Medicare will cover breast augmentation and what people need to do in order to get coverage.

Keep reading to learn more!

What types of breast augmentation surgery do Insurance and Medicare reimburse?

Medicare and health insurance funds only cover “medical” procedures that have medicare item numbers associated with them and are deemed necessary. So if a procedure is a purely cosmetic surgery, they will not provide any rebate.

Medicare has strict criteria to meet for surgery to be deemed “medical” and not cosmetic.

There are specific Medicare criteria you need to meet for surgery to be classed as “medical” and not cosmetic. In order for breast augmentation surgery or a breast lift to be covered and therefore be eligible for medicare rebates, it must be performed for the following reasons:

• To correct a congenital or developmental abnormality.
• To reconstruct the breast and breast tissue after mastectomy, usually in the context of breast cancer.
• To treat a medical condition that has resulted in a deformity of the breast.

If you’re considering breast augmentation or breast lift surgery for any other reason, it’s unlikely that Medicare will cover the cost. If you are still unsure, you can contact us at My Cosmetic Clinic and chat with our friendly staff or plastic surgeon.

What about other insurance companies?

Most health funds in Australia have a similar stance to Medicare when it comes to breast augmentation surgery. That is, your health fund will only cover the cost of the procedure if it’s being performed for one of the reasons listed above and has a medicare item number.

If you’re considering having a breast implant for cosmetic reasons, you’ll probably have to pay for the surgery yourself. However, it’s always a good idea to read through your private health insurance policy and check with your health insurance provider before having the procedure to make sure you’re not covered.

Breast reconstruction post-mastectomy

If you’ve had a mastectomy (breast removal surgery) due to cancer in your breast, Medicare will cover the cost of the reconstruction surgery. This includes plastic surgery, breast lift surgery, removal and replacement of breast implants, as well as any other surgery that’s required to reconstruct the breast.

Does Medicare cover the cost of breast implant removal?

Medicare will only cover the cost of breast implant removal if they were originally placed for a medical reason. For example, if you had the original implant after a mastectomy, Medicare would cover the cost of breast implant removal or replacement of implants.

However, if you had implants for cosmetic reasons, Medicare will not cover the cost of removing them. You would have to pay for this surgery out of your own pocket.

Medicare breast augmentation rebates

If you’re eligible for a Medicare rebate, you will only have to pay a portion of the total cost of the surgery. The exact amount will depend on a number of factors, such as the type of procedure you have and your Medicare status.

If you are considering a breast lift or augmentation for medical reasons, Medicare and most health insurance plans will partially cover the cost of the procedure. Breast augmentation can improve your quality of life by restoring symmetry to your bust and breast contour, increasing self-confidence, and improving your overall appearance.

Talk to My Cosmetic Clinic today to see if breast augmentation is right for you.

FAQs

Can you claim breast augmentation on Medicare?

Medicare will only cover the cost of breast augmentation or breast lift surgery if it’s being performed for a medical reason, that is if there is a medical need for this service. If you’re having the surgery for cosmetic reasons, you will not be eligible for a rebate.

What breast surgery is covered by Medicare?

Medicare supports any surgery deemed “medical” and that has an item number attached to it, such as breast reconstructive surgery post breast cancer or developmental abnormality that had resulted in unacceptable deformity of your breasts.

Is breast reconstruction covered by Medicare Australia?

Plastic surgery procedures for breast reconstruction are covered by Medicare Australia as long as they are deemed a medical necessity, such as post-mastectomy or other life-saving surgery.

Is breast reconstruction covered by my private health fund?

If the surgery has a medicare item number then most PHI providers will cover the cost of the procedure and hospital fees. It is always best to check with your provider and Medicare to see what’s covered and what eligibility criteria there are.

What is medically necessary surgery for the breasts?

A medically necessary breast surgical procedure is classed as any investigation or treatment of cancer, disorders and reconstruction or breast implant post a preventative mastectomy.