Will Medicare Fund My Breast Reduction? - Hunter Plastic Surgery

Are your large breasts causing you neck or shoulder pain or making it uncomfortable to exercise?

If you're thinking about a breast reduction in Newcastle, you might be wondering if Medicare will help with the cost. The good news is that it can, but only if you meet strict eligibility criteria. Here’s what you need to know about the Medicare rules for breast reduction.

Will Medicare help fund breast reductions in Australia?

Yes, Medicare will assist with the cost of breast reduction surgery if it is deemed medically necessary. This means your surgery must address specific health concerns rather than being purely cosmetic.

Who is eligible for a Medicare rebate for a breast reduction?

To qualify, your breast reduction MUST meet the following conditions:

• You experience chronic pain in your neck or shoulders due to the excessive size or weight of your breasts.
• You are not seeking to have an implant added to you breasts at the same time.

It is also very USEFUL if you can demonstrate that:

• You have persistent skin infections or rashes under your breasts.
• Your breast size significantly impacts your daily life, such as you have difficulty exercising.

How much will being eligible for a Medicare rebate save me?

For a patient without private health insurance: Medicare coverage means a rebate of around $1000.

For an insured patient, being eligible for a Medicare item number can reduce the cost by around $5000 or more!

The Medicare item number to check with your private health fund is 45523. Not all policies will cover this item, so you may consider a change to your cover or even your fund.

For more details on our fees, you can visit our breast reduction page.

How to apply for a Medicare rebate for a breast reduction

1. Visit your GP – Discuss your symptoms and request a referral to a specialist with a letter that demonstrates all your symptoms and medical concerns.
2. Consult a plastic surgeon – Your surgeon will assess whether you meet Medicare’s criteria.
3. Check your private health coverage – Contact your insurer to understand what costs are covered.
4. Submit a claim after surgery – After the procedure, submit your Medicare claim for a rebate of eligible costs. Find our step-by-step guide on how to process your Medicare claim here.

Can I have a breast reduction fully-funded by Medicare?

You may be eligible for a breast reduction in the public hospital system however there is very limited access and long wait lists. It is worth checking with the NSW Government Surgery Access Line on 1800 053 456 to see if there is a provider near you.