does medicaid cover breast reduction

Medicaid, the government-sponsored healthcare program, plays a pivotal role in providing essential medical services to low-income individuals and families across the United States. For individuals facing health issues related to excessively large breasts, breast reduction surgery can be a life-changing procedure. In this article, we will explore the question: Does Medicaid cover breast reduction surgery in America? We’ll delve into the factors that determine eligibility and the coverage options available.

does medicaid cover breast reduction

Medicaid coverage for breast reduction varies by state. In some states, Medicaid will cover breast reduction surgery if it is medically necessary. In other states, Medicaid will not cover breast reduction surgery at all.

To find out if Medicaid will cover breast reduction surgery in your state, you can contact your local Medicaid office. You can also search online for “Medicaid coverage for breast reduction in [state name].”

Here are some general guidelines for Medicaid coverage of breast reduction surgery:

  • The surgery must be medically necessary. This means that the surgery must be needed to treat a medical condition, such as chronic back pain, neck pain, or shoulder pain caused by large breasts.
  • The patient must have tried other, non-surgical treatments before surgery is considered. For example, the patient may have tried weight loss, physical therapy, or breast support bras.
  • The patient must meet certain financial eligibility requirements. Medicaid is a program for low-income individuals and families.

If you are considering breast reduction surgery and you have Medicaid, you should talk to your doctor about your options. Your doctor can help you determine if you meet the medical criteria for Medicaid coverage and they can help you apply for coverage.

Here are some additional tips for getting breast reduction surgery covered by Medicaid:

  • Be prepared to provide documentation. When applying for Medicaid coverage for breast reduction surgery, you will likely need to provide documentation of your medical condition, your non-surgical treatments, and your financial need. Be sure to have this information ready before you apply.
  • Be patient. It may take some time to be approved for Medicaid coverage for breast reduction surgery. Don’t give up! There are a number of resources available to help you get the surgery you need.

The Significance of Breast Reduction Surgery:

Breast reduction surgery, also known as reduction mammoplasty, is a medical procedure that aims to alleviate physical discomfort and psychological distress caused by excessively large breasts. Large breasts can lead to a range of issues, including chronic pain, skin irritation, posture problems, and emotional stress.

Medicaid Coverage and Eligibility:

As of my last knowledge update in September 2021, Medicaid may provide coverage for breast reduction surgery, but this coverage is subject to certain conditions and eligibility criteria. It’s important to understand that Medicaid is a state-administered program, and eligibility and coverage guidelines can vary from one state to another.

Eligibility Criteria for Medicaid:

Medicaid eligibility is primarily based on income, family size, and specific categorical requirements. Each state sets its own income limits and guidelines for determining eligibility. In the context of breast reduction surgery, individuals seeking coverage should meet the following criteria:

  1. Medical Necessity: Breast reduction surgery must be deemed medically necessary to alleviate physical symptoms, such as back pain, neck pain, or skin problems. In some cases, psychological distress may also be considered a valid reason.
  2. Physician’s Recommendation: A qualified healthcare provider, typically a plastic surgeon or a specialist, must recommend the procedure after a thorough evaluation of the patient’s physical and emotional well-being.
  3. Documentation: Detailed medical records and documentation that support the need for breast reduction surgery are often required. This documentation should include physical examination findings, patient history, and evidence of the impact of large breasts on the patient’s quality of life.

The Medicaid Approval Process:

If you believe you meet the eligibility criteria for breast reduction surgery under Medicaid, you can follow these general steps:

  1. Consult with a Healthcare Provider: Start by consulting a healthcare provider who specializes in breast surgery or plastic surgery. Discuss your symptoms and concerns to determine if breast reduction is medically necessary.
  2. Obtain a Recommendation: If the provider deems the surgery necessary, they will provide a recommendation for the procedure. This recommendation is a crucial part of the approval process.
  3. Contact Medicaid: Reach out to your state’s Medicaid office to inquire about the specific requirements and documentation needed for breast reduction surgery coverage. They will guide you through the application process.
  4. Submit Documentation: Compile all the necessary medical records, the recommendation from your healthcare provider, and any other documentation requested by Medicaid. Ensure that you provide a comprehensive case for medical necessity.
  5. Await Approval: Medicaid will review your application, and if approved, they will provide you with details on how to proceed with the surgery, including choosing an in-network surgeon.


Medicaid’s coverage for breast reduction surgery in America is a complex matter that hinges on medical necessity, physician recommendations, and adherence to state-specific guidelines. If you believe that breast reduction surgery is medically necessary for you or someone you know, it is crucial to consult with a healthcare provider and your state’s Medicaid office to navigate the eligibility and approval process effectively. This process aims to ensure that those suffering from the physical and emotional challenges associated with excessively large breasts can access the care they need and improve their overall well-being. Please note that Medicaid policies can change, so it’s advisable to verify the current guidelines with your state’s Medicaid program.

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