Does Aetna Cover Breast Reduction?
- Healthcare insurance may cover the costs of breast reduction surgery. Learn if Aetna covers breast reduction procedures and who is eligible for coverage.
Original Medicare (Part A and Part B) can cover breast reduction surgery if it's done to improve or correct asymmetry following a breast cancer surgery.
Medicare Advantage (Part C) plans like the ones sold by Aetna are required to offer at least the same benefits as Original Medicare, though some plans may provide more coverage for services than Original Medicare or may provide additional benefits.
Breast reduction surgery (reduction mammoplasty) is a procedure that involves removing breast tissue to reduce the size of the breasts. You may wish to have a breast reduction for cosmetic reasons or to relieve any pain and discomfort caused by having large breasts.
Breast reduction surgery without insurance coverage is expensive, so it's worth checking whether your insurer includes reduction mammoplasty as a benefit. This article explains Aetna breast reduction eligibility requirements and who may qualify for coverage.
Does Aetna Cover Breast Reduction Surgery?
Aetna health insurance plans may cover medically necessary breast reduction surgery in limited circumstances, and you should check your policy to see if it's a covered benefit.
You must be at least 18 years old or show completed breast growth (no change in breast size over at least a year) to qualify for Aetna breast reduction coverage. Furthermore, you must test negative for breast cancer on a mammogram a maximum of two years before your surgery if you are 50 or older.
When Is Breast Reduction Surgery Medically Necessary?
Aetna will usually cover reconstructive breast surgery following a medically necessary mastectomy if your policy covers the mastectomy itself. That's because the Women's Health and Cancer Rights Act (WHCRA) of 1998 requires all insurers to cover reconstructive procedures if they also cover mastectomy.
Therefore, you may receive coverage for breast reduction surgery to make your breasts appear symmetrical after a mastectomy or lumpectomy. Furthermore, Aetna may cover breast reduction surgery as part of a reconstructive procedure if your breasts are asymmetrical because of a traumatic injury.
Aetna Breast Reduction Coverage Exclusions
Aetna explicitly excludes cosmetic breast reduction surgery from all its policies. Therefore, you won't qualify for coverage if you don't meet the criteria for a medically necessary procedure or your breast size doesn't cause any physical symptoms.
Aetna Breast Reduction Documentation Requirements
Aetna will likely require medical evidence to demonstrate that a breast reduction procedure is medically necessary. Your doctor must provide photographic evidence showing significant breast hypertrophy if you need surgery to treat macromastia symptoms.
Furthermore, they may need to provide details of any conservative options you've tried to improve your condition and explain why breast reduction is the most appropriate next step. Your doctor should also certify that the procedure is likely to provide relief from your symptoms.
Helpadvisor.com is owned and operated by Tranzact, the parent company of TZ Insurance Solutions LLC, which is the owner/operator of Medicareadvantage.com and other websites mentioned on HelpAdvisor and which has a financial relationship with some of the carriers listed on HelpAdvisor.
