Does Medicare Cover Breast Reconstruction?
Yes. Medicare covers breast reconstruction surgery when it follows a mastectomy that was medically necessary because of breast cancer, treating it as reconstructive (not cosmetic) care. Coverage includes rebuilding the breast that was removed and, importantly, surgery on the other (unaffected) breast to make the two match for symmetry. Part A pays when the surgery is done during an inpatient hospital stay, while Part B pays for outpatient surgery, doctor services, external prostheses, and a post-surgical bra. You are still responsible for normal Medicare cost-sharing, such as the Part B deductible and 20% coinsurance, unless you have other coverage that fills those gaps.
Is breast reconstruction covered by Medicare?
Medicare covers breast reconstruction surgery if you had a mastectomy because of breast cancer. Because it restores the body after cancer treatment, Medicare treats reconstruction as medically necessary reconstructive surgery rather than cosmetic surgery.
Under Medicare's National Coverage Determination (NCD 140.2), coverage extends to rebuilding the breast that was removed and to surgery on the other, unaffected breast so the two match. In other words, Medicare will cover work on both breasts to achieve symmetry following a medically necessary mastectomy. Medicare does not, however, pay for breast surgery done purely for cosmetic reasons.
- Reconstruction of the breast affected by the mastectomy is covered.
- Surgery on the unaffected (contralateral) breast for symmetry is covered.
- Covered methods include implant-based reconstruction and autologous tissue flap procedures.
- Surgery to treat complications of a prior reconstruction, including revisions, is also covered.
- Reconstruction performed only for cosmetic reasons is not covered.
Which part of Medicare pays - Part A or Part B?
Which part pays depends mainly on whether your surgery happens during an inpatient hospital stay or in an outpatient setting.
Part A (Hospital Insurance) covers reconstruction and surgically implanted breast prostheses performed while you are an inpatient in the hospital. Part B (Medical Insurance) covers reconstruction done in an outpatient setting, the surgeon's and doctor's services, certain external breast prostheses, and a post-surgical mastectomy bra after a mastectomy.
If you are enrolled in a Medicare Advantage (Part C) plan, that plan must cover everything Original Medicare covers, including breast reconstruction. However, copays, provider networks, and prior authorization rules vary from plan to plan, so check your plan's Evidence of Coverage.
- Part A: inpatient hospital reconstruction and surgically implanted prostheses.
- Part B: outpatient surgery, doctor services, external prostheses, and a mastectomy bra.
- Part C (Medicare Advantage): must cover the same care; cost-sharing and rules differ by plan.
How much will breast reconstruction cost you in 2026?
Your out-of-pocket cost depends on whether the care is billed under Part B or Part A, and on any other coverage you carry.
For Part B-covered services - outpatient surgery, doctor services, and external prostheses - you first meet the Part B annual deductible of $283 (2026), then pay 20% of the Medicare-approved amount. To keep Part B coverage, most people pay the standard 2026 Part B premium of $202.90 per month.
For an inpatient hospital reconstruction stay, the Part A deductible of $1,736 applies per benefit period (2026). If the stay is long, hospital coinsurance is $434 per day for days 61-90, and $868 per day for lifetime reserve days. Most people pay no Part A premium if they have at least 40 quarters of Medicare-covered work.
- Part B deductible (2026): $283 per year, then you pay 20% coinsurance.
- Part B standard premium (2026): $202.90 per month.
- Part A deductible (2026): $1,736 per benefit period for an inpatient stay.
- Part A coinsurance (2026): $434/day for days 61-90; $868/day for lifetime reserve days.
- A Medigap (Medicare Supplement) policy can help pay the 20% Part B coinsurance and other gaps; benefits depend on which Medigap plan you have.
External breast prostheses and mastectomy bras
If you choose not to have reconstruction, or in addition to it, Medicare Part B covers some external breast prostheses and a post-surgical mastectomy bra after a mastectomy. As with other Part B items, you generally pay 20% of the Medicare-approved amount after meeting the Part B deductible.
External prostheses can be replaced on a schedule. Silicone prostheses are generally replaced about every 2 years, and fabric, foam, or fiber-filled prostheses about every 6 months. A prosthesis can be replaced sooner if it is lost or damaged beyond repair.
- Silicone external prostheses: replaced approximately every 2 years.
- Fabric, foam, or filled prostheses: replaced approximately every 6 months.
- Earlier replacement is allowed if the prosthesis is lost or irreparably damaged.
WHCRA, cosmetic rules, and what is not covered
The Women's Health and Cancer Rights Act (WHCRA) of 1998 requires many group health plans and individual insurance policies to cover breast reconstruction, but the WHCRA does not apply to Medicare or Medicaid. Even so, Medicare covers reconstruction under its own rules (NCD 140.2), so the protection effectively exists for Medicare beneficiaries through those coverage rules.
Medicare generally does not cover cosmetic surgery. There are exceptions: surgery needed because of accidental injury or to improve the function of a malformed body part can be covered. Breast reconstruction after a cancer mastectomy meets Medicare's medically necessary standard, which is why it is covered rather than excluded as cosmetic.
- WHCRA governs many private and employer plans, not Medicare or Medicaid.
- Medicare covers reconstruction under NCD 140.2, its own coverage rule.
- Purely cosmetic breast surgery is excluded from Medicare coverage.
- Coverage of reconstruction for a non-cancer mastectomy depends on whether Medicare finds it medically necessary; confirm the specifics with your plan or provider before scheduling surgery.
Frequently asked questions
Does Medicare cover reconstruction of the unaffected breast for symmetry?
Yes. Under NCD 140.2, Medicare covers surgery on the contralateral (unaffected) breast to make it match the reconstructed breast following a medically necessary mastectomy. Medicare treats this symmetry procedure as non-cosmetic, so it is covered like the rest of the reconstruction.
Does Medicare cover implant reconstruction, tissue flap reconstruction, or both?
Both. Medicare covers implant-based reconstruction and autologous tissue flap procedures, as well as surgery to treat complications of a prior reconstruction, such as revision surgery. The method used is a clinical decision made with your surgeon.
Will a Medigap plan cover the 20% coinsurance for reconstruction?
For Part B-covered reconstruction services, you pay 20% of the Medicare-approved amount after the deductible. A Medigap (Medicare Supplement) policy can help pay that coinsurance and other gaps, but exactly what is covered depends on which standardized Medigap plan you have.
Does Medicare Advantage (Part C) cover breast reconstruction?
Yes. Medicare Advantage plans must cover everything Original Medicare covers, including breast reconstruction. However, copays, provider networks, and prior authorization requirements vary by plan, so review your plan's Evidence of Coverage and ask whether prior authorization is needed.
How often will Medicare replace an external breast prosthesis?
Silicone external prostheses are generally replaced about every 2 years, and fabric, foam, or filled prostheses about every 6 months. A prosthesis may be replaced sooner if it is lost or damaged beyond repair.
Does Medicare cover breast reconstruction done only for cosmetic reasons?
No. Medicare generally does not pay for cosmetic surgery and does not make payment for breast reconstruction performed for cosmetic reasons. Reconstruction after a cancer mastectomy is covered because Medicare considers it medically necessary, not cosmetic.
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Medicare Login Guide is an independent resource and is not affiliated with or endorsed by Medicare, the Centers for Medicare & Medicaid Services, or any government agency. This article is for general information only — confirm current figures and your specific options at medicare.gov or by calling 1-800-MEDICARE.