Are All Mastectomy Products Covered by Insurance?
The Women’s Health and Cancer Rights Act of 1998 (WHCRA) offers protection for mastectomy patients for any type of breast cancer surgery or reconstruction. It ensures that insurance companies cover the cost of a variety of necessary mastectomy products, including breast forms, mastectomy bras, and post-surgical compression bras.
Whether you have Medicare, Medicaid, or private health insurance, all have insurance plans that are designed to facilitate a fast and comfortable recovery. However, there may be limitations to what you can claim.
Most standard insurance covers between 4-6 post-surgery bras each year, depending on your provider, level of coverage, and medical needs. The style of bra also impacts your eligibility for coverage. Most providers only allow claims on pocketed post-mastectomy bras.
Claims on a mastectomy bra are typically not processed until after your surgery. We suggest coming in for a professional bra and breast form-fitting at 4-6 weeks after your mastectomy to allow for post-surgical swelling to subside and the site to heal properly.
Many health insurance providers, excluding Medicare and Aetna, offer coverage for custom breast prostheses. You are eligible for a new custom breast prosthesis every 2 years. You can also get a new lightweight foam breast form every 6 months on most commercial insurance plans.
Suppose you require a new breast prosthesis or bra due to loss, damage, or weight fluctuations. In that case, you may be able to purchase and claim additional products if you obtain a prescription from your doctor, deeming them medically necessary.
Most insurance companies will cover between 80-100% of the cost for your full cranial prosthesis and will allow you to receive one cranial prosthesis per year for medical hair loss. Depending on your insurance, your prosthesis may also be a tax-deductible medical expense.
Compression garments are often necessary after extensive breast surgery and lymph node removal to prevent lymphedema. Unfortunately, Medicare does not provide coverage for compression sleeves or tights. However, you may be eligible for a compression vest, bra, or chest belt under your current plan.