Covered under Medicare?

Was wondering if a breast reduction can be offered under medicare if it causes health problems such as back problems and self esteem issues?

pande13 August 25th, 2016 QLD

  • Answer
    Dr. Raymond Goh

    Raymond Goh

    123 answers

    Plastic Surgeon
    Queensland, Australia

    Hi Pande13. 
    Thank you for your question. Breast reduction has a medicare item number, and is therefore considered a medical procedure, performed for a medical condition. There are two avenues for surgery: public and private. In the public system, there is no cost for the patient, as long as you have a medicare care/number. There is often however, a very long (years!) wait list for this procedure under the public system and given its generally done in teaching hospitals, there is no assurance of who the operating doctor will be (surgeon, fellow, training surgeon etc). In the private sector, if the patient has private health insurance and depending on their cover, part of the surgical, anaesthetic, and hospital cost will be covered by the insurance. There is however generally still some out of pocket costs involved.
    Hope this information is of help.
    All the very best.
    Dr Ray GohValley Plastic Surgery
  • Answer
     Robert Drielsma

    Robert Drielsma

    191 answers

    Plastic Surgeon
    New South Wales, Australia

    Thanks for your question.  Breast reduction surgery attracts a Medicare rebate and is considered to be surgery for a medical condition.  You have two options.  You can attempt to have breast reduction performed in a public hospital.  Most public hospitals have basically stopped allowing this procedure to be done in their facilities and should one allow this, typically the waiting time is many years and surgery is usually performed in a teaching hospital by Doctors training to learn new procedures.  More realistically, you can have the procedure performed privately by a fully qualified specialist plastic  surgeon.  You will be able to claim a Medicare rebate on your surgeon’s fees but you will need to fund hospital costs.  Typically in the private sector your procedure can be arranged within a matter of months.  If you have private health insurance your hospital fees may also be covered and you will receive further rebates on your surgical fees.