Your Medicare Coverage

Is my test, item, or service covered?

Breast prostheses

How often is it covered?

Medicare Part B (Medical Insurance) covers external breast prostheses (including a post-surgical bra) after a mastectomy.

Medicare covers surgically implanted breast prostheses after a mastectomy. Medicare Part A (Hospital Insurance) covers the surgery if it takes place in an inpatient setting. Part B covers the surgery if it takes place in an outpatient setting.

Who's eligible?

All people with Medicare Part A and/or Part B are covered.

Your costs in Original Medicare

You pay 20% of the Medicare-approved amount for the doctor's services and the external breast prostheses. The Part B deductible applies.

For surgeries to implant breast prostheses in a hospital inpatient setting, you pay the Part A hospital care costs.

Note

To find out how much your test, item, or service will cost, talk to your doctor or health care provider. The specific amount you’ll owe may depend on several things, like:

  • Other insurance you may have
  • How much your doctor charges
  • Whether your doctor accepts assignment
  • The type of facility
  • Where you get your test, item, or service

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