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Breast Implants and Health Insurance

In the U.S., getting breast augmentation surgery -- breast implants for cosmetic reasons -- cost an average of $5,278 in 2011. 

Most women have to pay that out of their own pockets. Insurance usually will not cover breast enlargement surgery. It will, though, cover breast implants for women who have had mastectomies due to breast cancer.

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Women can get breast implants to make their breasts bigger and fuller. That can be done for reconstructive purposes, such as after mastectomy for breast cancer, or for cosmetic reasons. This article covers cosmetic breast augmentation only. It discusses the types of breast implants available, the procedures used, and possible complications.    

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If you need further surgery later on, your health insurance may not cover that, either. Having breast implants may also affect your insurance rates later on.

5 Questions to Ask Your Health Insurance Company

Before you get breast implants, ask your insurance company these five questions:

  1. If I get breast implant surgery, will any of the costs be covered?
  2. Will getting breast implants affect my insurance rates or coverage? 
  3. If I have health complications related to my breast implants, will the necessary treatment or surgery be covered?
  4. Will having breast implants affect my coverage if I later develop breast cancer or other breast problems?
  5. Will any of the diagnostic tests that I may need after getting breast implants, such as MRIs or extra mammogram images, be covered?

Get the answers in writing and check back with your insurance company every couple of years, since it may change its policy. 

Additional Costs of Breast Implant Surgery

If you're looking into the costs of breast implants for cosmetic reasons, you should also consider:

  • Additional Charges at the Time of Surgery. Ask your doctor about all the costs, including the implants, anesthesia, hospital fees, medication, and any other charges. Some surgeons include everything in their fee. Others don't.
  • Further Surgeries. Women who get breast implants usually need another surgery at some point. Some women need additional surgery right away. For example, they may have an allergic reaction or want to adjust the position of the implant. Others may need to replace the original implants years later. Like most medical devices, breast implants don't last forever. Some implant makers offer lifetime guarantees. If the implant breaks, the company will offer a replacement at no cost. However, check the details. The warranty may not include the cost of the surgery or other expenses. Keep in mind that removing breast implants can cost more than putting them in.
  • Diagnostic Testing. The FDA recommends that women with silicone breast implants get an MRI three years after implantation and once every two years after that. This is the only way to make sure the silicone implant hasn't ruptured. Women with saline implants do not need these tests. MRIs can be expensive. The average cost of an MRI in the U.S. is $2,000.

Because breast implants can interfere with the accuracy of normal mammograms, women may also need extra X-ray images at additional cost. Health insurance probably will not cover these extra diagnostic charges. Ask your health insurance company ahead of time so you know what to expect.

Insurance Eligibility and Breast Implants

Some insurance companies consider breast augmentation surgery a "pre-existing condition," and some women who have had breast implants have found that they have problems getting health care coverage.

The Affordable Care Act prevents health insurance companies from denying people coverage due to pre-existing conditions. 

  • Charge higher premiums.
  • Limit your coverage. For instance, some insurers won't cover diseases of the breast - including breast cancer -- if you have breast implants.
  • Deny you coverage altogether.
  • Refuse to renew your policy.

 

WebMD Medical Reference

Reviewed by Michael J. Wheatley, MD on July 08, 2012
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