Will Health Insurance Pay for Breast Implants?

Health insurance coverage can be tricky. Trying to figure out what services are and aren’t covered by your plan can seem like a daunting process, especially when it comes to something like breast implants.

Will your insurance cover the cost of breast implants? Like most questions related to health insurance, the answer is: “it depends”. The purpose for the implants, as well as the specifics of your policy will determine whether or not your insurance will pay for breast implants.

What is Breast Implant Surgery?

Breast implants, or breast enlargements (medically referred to as augmentation mammoplasty), is a surgical procedure that increases the size and improves the shape of the breasts. The procedure involves placing implants, which are constructed of saline or silicone and housed within a shell that is made of soft silicone, either underneath the breast tissue or underneath the muscles of the chest that lie beneath the breast. The implant may be placed through an opening cut in the bottom of the breast, along the bottom part of the areola, or through the underarm. During the procedure, the breasts may also be lifted to improve their appearance.

Reasons for Breast Implant Surgery

The primary purpose of breast augmentation surgery is to increase the size and shape of the breasts. Generally, it’s an elective surgical procedure, and there are four main reasons why you may consider having it done:

1. You think your breasts are too small and you want to increase their size and shape.
2. Your breasts have decreased in size as a result of pregnancy or weight loss and you would like to restore them to their original size and shape.
3. Your breasts are different sizes; one may be larger than the other and you want them to be more symmetrical.
4. You had breast cancer or cancerous cells were detected and you had a mastectomy (the surgical removal of one breast) or a double mastectomy (the surgical removal of both breasts), you were involved in an accident and your breasts were damaged, or the size and shape of your breasts were altered for other reasons outside of your control and you want to reconstruct the breast(s) that were removed.

Whatever the reason you are considering breast implant surgery, together, you and your doctor will need to determine whether or not it is the best option for your needs.

Will Insurance Cover the Cost of Breast Augmentation Surgery?

Breast augmentation surgery can be costly, and the out-of-pocket expense may ultimately determine whether or not you decide to have the procedure done. If you have health insurance, you may assume that the breast implant surgery will be covered; however, that isn’t necessarily the case. As stated previously, it depends on the purpose of the surgery.

• Cosmetic. If the reason for breast implant surgery is purely cosmetic – you want to improve the size and shape of your breasts – it will not be covered by your carrier. Regardless of  your policy, no health insurance company will cover the cost of any elective cosmetic procedure, including breast augmentation.
• Reconstruction. If you had a mastectomy or a double mastectomy as a result of breast cancer, or you were involved in an accident, breast implant surgery may be covered by your health insurance company. In these cases, reconstruction surgery may involve breast implants, and the procedure may be viewed as medically necessary. It is important that you speak to your provider, however, as it depends on the specifics of your plan and your purpose for having the procedure. Even if your policy will cover the expense, it is likely that you will still be responsible for a portion of the surgery.

What if Health Insurance Won’t Pay for Breast Implants?

If your health insurance plan won’t cover the cost of breast augmentation surgery, there are other options available that may be able help with the expense. Some of these options include:

• Credit cards. You can use a standard credit card, or apply for a medical credit card to pay for the surgery. Medical credit cards are similar to standard credit cards; however, they can only be used to pay for medical expenses.
• Loans. Personal, home equity, and 401(k) loans may be another way to cover the expense of breast implant surgery. Do make sure that you read the fine print and fully understand the terms and conditions that apply to the loan so that you can avoid financial trouble down the road.
• Payment plans. Many cosmetic surgeons offer payment plans, which can make covering the cost of breast augmentation more manageable. Speak to your surgeon to find out what type of payment plans, if any, are available

Conclusion

If you are considering breast implant surgery, the reason for the procedure and your specific policy are the two factors that will determine whether or not your carrier will cover the cost. Speak to your health insurance company to find out; if the procedure isn’t covered, there are other options available to assist with the cost of procedure.