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Is Breast Reduction Surgery Covered by Medicare?

Is Breast Reduction Surgery Covered by Medicare?

Is Breast Reduction Surgery Covered by Medicare?

  • At this point in time, the answer is still “Yes” and there is no fine print attached.
  • Every breast reduction performed has a Medicare eligible item number.
  • This does not mean that all of your fees are covered.
  • It means you will get a set rebate on your surgeon’s fees and anaesthetic fees.
  • Hospital fees are never covered by Medicare.

What does this mean in financial terms?

  • All breast reduction surgery is paid for before your surgery.
  • After the date of surgery, you can claim the schedule fee rebate of $1029.25 on a bilateral breast reduction
  • The cost of breast reduction will vary from one surgeon to the next.

Will my Private Health Fund cover the costs of breast reduction surgery?

  • If you have private health insurance, including hospital cover with no exclusions, your health fund should cover all hospital fees (with the exception of any co-payment arrangement you may have)
  • You may still have out-of-pocket costs for your anaesthetist and your surgeon.
  • Your surgeon’s theatre booking staff will be able to give you exact information on what you will and won’t be covered for with your level of cover.

Can I have a breast reduction in a public hospital?

  • Technically yes. You will be placed on a waiting list as a Category 3
  • All Category 1 and Category 2 clients must be operated on in a timely fashion, or the hospital is penalised financially.
  • Once this has occurred, Category 3 clients are called forward in order of how long they have been on the waitlist.
  • This process often takes many years.

How do I choose a surgeon for my breast reduction surgery?

  • When it comes to surgery on your body, cost should be your last consideration.
  • We would recommend choosing a surgeon according to his/ her level of skill and the results posted on their website, as opposed to cost.
  • When looking at results, you want a surgeon that has many examples of the breast reductions they have performed. Everyone will have a few good results. Choose someone with loads of before and afters, with consistently good results.