Does Medicare cover breast prostheses?

Does Medicare cover breast prosthesis? Medicare will cover most prosthetic devices as long as they are ordered by a doctor who is enrolled in Medicare. A surgery bra will be covered under Medicare Part B, and you will have to pay the Part B deductible as well as the 20 percent coinsurance.

A partial breast prosthesis can be worn with a regular bra or a post-mastectomy bra.

If you have Medicare Supplement insurance, you could have some or all of the out-of-pocket costs covered. Medicare Advantage health insurance plans may also have a lower out-of-pocket amount, depending on your plan.

To compare options for a Medicare plan that covers breast prosthesis with no out-of-pocket costs, enter your ZIP code now.

What is the Medicare coverage for breast prostheses?

According to Medicare.gov, breast prostheses are covered under your Part B coverage. These are covered only when a Medicare-enrolled doctor determines that they are needed and writes a prescription for the prosthetics. A mastectomy bra is usually prescribed after breast cancer surgery, but there may be other conditions that require the use of breast prosthetics.

Speak to your certified mastectomy fitter for more information on what coverage your specific plan or policy covers.

If you have Medicare Advantage, your coverage will depend on the plan you have selected. Medicare Advantage plans cover the same things as Original Medicare but may have additional coverage available.

What is the cost of breast prosthesis with Medicare?

The cost of a single breast prosthesis can be as much as $500, which adds up to $1000 for a pair of prostheses. Medicare will cover that at 80 percent after your Part B deductible is met, with a 20 percent health care coinsurance. Odds are good that the treatment for which you are in need of the prosthesis will have already covered that deductible. If you have a Medicare Supplement plan, you could have reduced costs or no costs at all. That depends on the plan you select.

Cost out-of-pocket for breast prostheses with Medicare Advantage will vary. Plans may cover the surgical bra and prosthesis at 100 percent in some cases, with no deductible. Contact your plan provider to find out what your cost will be.

Read more: Does Medicare cover breast implant replacement?

What is a breast prosthesis?

A breast prosthesis is an artificial breast that is used to simulate the natural breast and body shape. Depending on the type of surgery ( lumpectomy mastectomy ), a woman can have full or partial breast prostheses to balance her appearance. The prostheses are typically made out of silicone, foam, or fiberfill and they are worn inside a bra or attached to the body with special adhesive.

Read more: Does Medicare cover breast reconstruction after a lumpecto?

How soon after surgery can I be fitted for my breast prosthesis and mastectomy bra?

Usually, the fittings take place 6-8 weeks after surgery. It is important patients receive permission from their physicians to move forward with a fitting.

Does Medicare cover mastectomy sleeve cost?

Mastectomy sleeves which are used to control swelling are not covered in the home setting because they do not meet Medicare’s definition of prosthesis; however, it is possible that they may be covered under the hospital per diem if you request one during your hospital stay.

Will my health insurance cover post-mastectomy products if I had breast reconstruction?

Yes, your health insurance should cover bras, breast prosthesis, breast forms and camisoles whether you had breast reconstruction if they are medically necessary.

Case Studies: Medicare Coverage for Breast Prostheses

Case Study 1: Medicare Coverage for Breast Prostheses (John)

John, a Medicare beneficiary, had a mastectomy and needs a breast prosthesis. Medicare Part B covers the prosthesis, but John must pay the deductible and 20% coinsurance. He chose a Medicare Supplement plan to help with these costs.

Case Study 2: Cost of Breast Prosthesis With Medicare (Sarah)

Sarah had a mastectomy and wants breast prostheses. Medicare covers 80% of the $1000 cost, leaving her with a $200 coinsurance. Luckily, Sarah’s Medicare Supplement plan covers the coinsurance, so she pays nothing.

Case Study 3: Medicare Coverage for Mastectomy Sleeves (Mark)

Mark had a mastectomy and needs a mastectomy sleeve to control arm swelling. Medicare doesn’t cover sleeves at home, but they may be covered during a hospital stay under the per diem payment. Mark discusses this option with his healthcare provider.

Does Medicare cover breast prosthesis? The Bottom Line

Medicare does cover breast prosthesis and mastectomy bras at 80 percent after your deductible. You’ll avoid paying out-of-pocket costs if you have the right Medicare Supplement plan.

To look for a Medicare plan that covers breast prosthesis at no out-of-pocket costs, enter your ZIP code now.