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Tuesday, December 22, 2009 charcoal, Community Member, asks

Q: Does medicare cover breast reconstruction after a mastectomy?

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Answers (2)
PJ Hamel, Health Guide
12/22/09 5:20pm

Well, yes and no. Medicare will pay something towards reconstruction, but it's often less than what a plastic surgeon is willing to accept, so many don't choose to perform reconstruction on Medicare patients. Your best bet is to ask the social workers at your hospital to help you find a plastic surgeon who operates within the Medicare system. Good luck - PJH

Done with Cancer!, Community Member
1/ 6/10 2:28pm

It is interesting that the Women's Health Act of 1998, also called "Janet's Law" has a big loop hole.  This law came about as a result of Janet Franquet being denied reconstruction after cancer in 1997 because it was "cosmetic".  She was treated during a lengthy appeals process, which she eventually won.  Former New York Sen. D'Amato sponsored the law that was signed on Oct. 21, 1998.


The law states (briefly) that if a health insurer covers the mastectomy surgery, they must cover reconstruction, symmetry on the other side if needed and subsequent complications.  However, the law does not include those covered by Medicare.  So each state may have different rules that apply to reconstruction treatment.

The bottom line here is that getting cancer after 65 is much more challenging that it has to be because of this loop hole.

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By charcoal, Community Member— Last Modified: 12/27/10, First Published: 12/22/09