Medicare and Medicaid coverage of risk-reducing surgery varies


MedicareSenior Women Meeting with Doctor

Medicare’s policy is that you must have signs or symptoms of cancer to qualify for surgery. For this reason, Medicare generally does not cover preventive surgeries although people in some regions have succeeded in getting coverage.

Visit the Medicare website or call 1-800-MEDICARE (1-800-633-4227) to learn more about what your plan covers and how to manage claims and appeals.

Medicaid

Medicaid coverage of risk-reducing surgeries such as mastectomy (removal of breasts), hysterectomy (removal of uterus) or salpingo-oophorectomy (removal of ovaries and fallopian tubes), as well as breast reconstruction after mastectomy varies by state. 

Contact your Medicaid office to learn more about access to these services in your state.

paying-for-service
  • Kaiser Family Foundation has a database of Medicaid benefits, searchable by state and sorted by type of assistance.
  • Medicare provides a Procedure Price Lookup tool that shows how much Medicare pays for certain procedures and the average copayment for a beneficiary without Medicare supplemental insurance. 
  • Medicare Rights Center is a national nonprofit organization that works to ensure access to affordable health care for people with Medicare.
  • Patient Advocate Foundation provides case managers who help identify financial assistance programs and resources for those facing challenges.