Will Medicaid Pay To Remove My Breast Implants?

Medicaid is a program that pays for medical costs for people with low incomes or limited resources. It is paid for by both federal and state governments.

Each state decides exactly what services will be paid for and how much they cost. In order for implant removal or any other service to be covered, your doctor must tell Medicaid that the service is medically necessary.

Because each state has different policies, you’ll have to do some research to find out whether your implant removal surgery will be paid for in the state where you live.

Even though each state runs its own Medicaid program, there are still guidelines they have to follow. All Medicaid patients across the country are entitled to certain medical services, including prevention services and screenings.

Where to Start

  1. You should make an appointment with your primary care doctor. Under Medicaid, that doctor is your “primary care coordinator.” Your doctor will have to approve the procedure and ask Medicaid if they will cover the costs.
  2. If your primary care doctor is part of an HMO (Health Maintenance Organization), he or she will refer you to a surgeon within the HMO. You may be required to use an HMO surgeon in order for Medicaid to cover the cost. If your HMO doesn’t have a surgeon who can do the surgery, you might be referred to a surgeon outside the network.
  3. If your primary care doctor is not part of an HMO, she/he may be able to tell you which surgeons in your area will accept Medicaid patients.

If you have Medicaid and Medicare

Dual Eligible Beneficiaries

People who are enrolled in both Medicare and Medicaid are called “Dual Eligible Beneficiaries.” They are enrolled in Medicare Part A and/or Part B and receive full Medicaid benefits and assistance with Medicare premiums.

If you are dual eligible, Medicare will pay for your medical services first. Medicaid may cover the cost of care that Medicare won’t. You should speak with your primary care doctor about the specifics.