Will Medicare cover Double Mastectomy?

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Christene502
Christene502 Member Posts: 115
edited April 2019 in Surgery - Before, During, and After

My primary ins is Medicare and do have secondary coverage.

I have breast cancer in my left breast. Had 4 biopsies. Breast Ultrasound Bilateral test reports I have 5.5 x 2.2 cm nodular 1 cm from the nipple, 6 mm septated cyst not seen on prior exams on the Right breast. MRI report states there are few scattered right breast cysts.

May 6th I am scheduled to have BMX. I am wondering if Medicare will cover double mastectomy being I did not have a biopsy done and what the tests results show?


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  • Irishlove
    Irishlove Member Posts: 82
    edited April 2019

    I'm waiting to see the surgeon end of April to request a prophylactic mastectomy. I had the other breast removed end of Feb. due to what we thought was invasive b.c. It turned out pathology was incorrect and I was re-diagnosed with encapsulated papillary carcinoma. I saw the MO this week we talked about Medicare paying for the surgery. I have Medicare Advantage. It's a tough sell, but since I am experiencing horrible backache (I also have scoliosis), and exceptionally strong family history of b.c, can not take a.i.'s or tamoxifen (I have MS), she thinks it will be approved (with the emphasize on the severe backache guidance). I'm not sure this bodes well since you plan on BMX at the same time. Hopefully someone else will have more info that will help.


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  • Christene502
    Christene502 Member Posts: 115
    edited April 2019

    Irishlove - For the past couple of weeks I have had a backache. I thought it was my bed. Ran out and bought a new bed... Nope that wasn't the answer. Still have back pain.... Wondering if I should mention this to my oncologist?

    When you mentioned Carcinoma. I remembered reading that on one of my reports.... MRI that was done Jan '19... Impression new 6x5cm curvilinear enchancement within the posterior left breast, in the region of the previously identified left breast Carcinoma. That's when my Breast Surgeon requested another MRI with Biopsy. Biopsy stated Moderately differentiated invasive ductal carcinoma Estrogen receptor ER Positive. 90% strong. HER-2 Negative.

    My mom at 54 had invasive breast cancer... so I can now say it runs in the family.

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  • bcincolorado
    bcincolorado Member Posts: 5,758
    edited April 2019

    Carcinoma is cancer that will need to come out. Your Medicare and supplement should cover but you probably have co-pays you will have to cover. The practice staff and hospital staff can help you navigate and figure out what costs you are going to be responsible for. Some places they accept what is covered and some do not. If it will cover your "non-cancer side" or not to be proactive if you are concerned they can answer that as well. If it is something that you chose to have done some places allow payment options as well. Best of luck to you.

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