There is no one policy for all the states that only allow the Medicaid to pay for breast implant removal in some circumstances. In general, patients who have problems with their breast implants under the state Medicaid program are not eligible for coverage of these procedures.
In this guide, we review thee aspects of: Will Medicaid Pay For Breast Implant Removal, does medicaid cover breast implants, What is the recovery time for breast implant removal, and When should breast implants be removed?
Removing breast implants may be necessary if the implants are causing discomfort or pain, preventing treatment for other medical conditions, or if they are simply due to be removed or exchanged in the normal course of use. Medicare coverage for this surgery may be available under certain circumstances.
Why Remove Breast Implants?
Depending on the circumstances, this surgery may be elective or necessary. Several medical conditions or cosmetic needs can lead to breast implant removal.
These are the most common reasons for removal:
Your healthcare professional may perform a series of diagnostic tests to determine the necessity of an implant removal surgery. In cases where there is an infection, you may also receive a prescription for antibiotics.
Risks Associated with Breast Implant Removal
Although serious or urgent medical conditions may require you to undergo breast implant removal, you may be vulnerable to certain risks during recovery and beyond. Your healthcare professional can help you assess the probability of these issues before the surgery. There may be follow-up procedures or medications prescribed to you to help manage those risks.
Surgical risks can include excessive bleeding, clotting, swelling and pain that persists throughout recovery. Infection or improper healing at the incision site may also increase pain, scarring, skin loss and delay recovery from breast implant removal. Loss of sensation or numbness may occur in and around the breast tissue.
Monitor your symptoms closely and alert your healthcare professional of any changes to your condition throughout recovery in order to prevent these symptoms from worsening. Discuss any allergies to medication or pre-existing medical conditions with your healthcare professional to minimize any risks or complications that could occur.
Medicare Coverage for Breast Implant Removal
Original Medicare Part A and Part B provide benefits that help cover the costs of hospital stays and outpatient services related to many surgeries. Surgery for breast implant removal may qualify as a covered medical procedure if the need for the surgery meets certain criteria.
In general, Medicare’s benefits apply to medically necessary treatment for covered conditions. If your breast implants must be removed because the outer shell has broken, there is an infection or it prevents treatment for breast cancer, it may qualify for Medicare coverage through Part A.
Most recipients receive Part A (Hospital Insurance) coverage premium-free. If you pay a premium for Part A, then this premium must be paid in order for Part A to cover the cost of services after your deductible has been met. If you attend outpatient services before or after surgery to help diagnose or monitor your condition, this would fall under Medicare Part B (Medical Insurance) coverage. You will be responsible for monthly premiums, copayments or coinsurance costs and the Part B deductible must be met. If you have purchased a Medigap, or Medicare Supplement, plan, it will help cover the costs that Original Medicare does not, such as deductibles, coinsurance and copayments.
Medicare Advantage plans are required to provide at least the same coverage as Original Medicare Part A and Part B, but many offer additional benefits, such as prescription drug coverage. If you have a Medicare Advantage plan will prescription drug coverage, or if you have Original Medicare and have enrolled in a stand alone Prescription Drug Plan (PDP), your coverage may help pay for certain prescription medications your physician may order for your post-operative care.
Will Medicaid Pay For Breast Implant Removal
If you’re on Medicaid and are considering having breast implants removed, don’t worry: Medicaid may still cover the cost of your surgery. In fact, if you’re not currently on Medicaid (or in need of other health care services), there are a few ways to make sure that removing your breast implants is affordable.
Go to your state’s Medicaid website and check the benefits.
If you’re still unsure whether or not your state will cover breast implant removal, the best thing to do is visit their website and look for a list of covered services. If you can’t find it there, search through the rest of the website until you come across something that looks like it might give answers. You may also want to check out what other services are covered in your area–this way, if Medicaid does not cover breast implant removal but does pay for something else related (like mammograms), then at least we’ll know where our options lie.
Check if you are eligible for Medicaid, even if you currently have no coverage.
If you are low-income and meet other eligibility requirements, Medicaid may be able to help cover the cost of breast implant removal.
Medicaid is a federal program that provides medical coverage to low-income people. It’s administered by each state, so eligibility requirements vary from state to state. You can apply for Medicaid even if you currently have no coverage–and even if your state does not offer it (at least not yet). You can also apply for Medicare at any time during the year, even if it’s after open enrollment has ended or when there’s no qualifying life event like having a baby or getting married/divorced/separated/etc., as long as one of those things happened within 60 days prior to applying for Medicare Part A & B or just Part B alone (you don’t need proof).
If you’re not eligible for Medicaid, try to find a way to lower your income.
If you’re not eligible for Medicaid, try to find a way to lower your income.
- Get a part-time job. Sell your car and move in with family or get a roommate. Don’t spend money on things you don’t need–don’t pay for cable and don’t buy new clothes or furniture (unless these are things that will help improve your quality of life).
Try to get a hardship exemption.
- You can apply for a hardship exemption if you have a medical condition that prevents you from working. Examples include chronic pain and mental illness.
- You can also apply for an exemption if you’re caring for a family member with a serious health condition, such as cancer or HIV/AIDS.
Look into getting approved for Social Security Disability Insurance.
If you’re unable to work for at least 12 months, Social Security Disability Insurance may be an option. The process takes about six months and involves filling out a questionnaire and providing medical documentation from your doctor. You’ll need to provide proof that the surgery is necessary for your health and well-being.
If approved, Medicaid will pay for breast implant removal as long as it’s done within one year of being denied Social Security Disability Insurance.
Ask doctors if they’ll work with you on the cost of a surgery.
You can ask the doctor if they will work with you on the cost of surgery. Doctors may be willing to negotiate with you, and there are several ways that this might happen:
- Ask for a payment plan. You might be able to split up your payments over time, which allows you more flexibility in paying off larger bills without paying interest or incurring other financial penalties.
- Ask for a discount on services provided by the doctor’s office (such as lab work). This is usually only available if it’s clear that there’s no other option but surgery–and even then, it depends on how much money is involved in the procedure itself! It never hurts to ask though!
- Ask about cash prices vs insurance rates; sometimes doctors will offer discounts if they know they won’t get paid out by insurance companies anyway because their procedures won’t qualify under certain criteria set forth by those companies’ policies.”
Consider applying for financial aid or grants.
If you’re not sure that you can afford to pay for the removal, consider applying for financial aid or grants. You may be eligible to receive a loan, credit card and/or personal loan. If you own your home, explore options such as a home equity loan or mortgage refinance.
You can still get your implants removed even if Medicaid won’t pay for it.
If you’re worried about the cost of breast implant removal, don’t be. There are several ways to cover the costs of surgery and/or recovery.
- You can apply for financial aid through Medicaid or private insurance companies. If they reject your claim, ask them why they did so and what documentation they need from your doctor before re-applying.
- Talk to your doctor about how much it would cost for them to remove your implants as well as any other procedures related to this process (such as additional surgeries). If there’s something else that needs fixing or replacing after removing the implants, then make sure those procedures are included in their quote so that everything is covered by one payment rather than two separate payments made at different times during recovery timeframes.* Also keep in mind that some health care providers might work directly with patients on payment plans if they have trouble paying up front; doctors often have relationships with local charities who provide free care or discounted rates based on income level.*
does medicaid cover breast implants
Breast cancer is devastating for anyone to experience, but losing one or both breasts to the disease can be especially difficult for women. The decision to undergo breast reconstruction after a mastectomy, which is the term used to describe the surgical removal of breasts due to cancer, is not always an easy one to make. It can become even more challenging when insurance coverage is an issue. Fortunately, the federal government stepped in nearly two decades ago to make coverage for breast cancer reconstruction mandatory in certain situations.
The Women’s Health and Cancer Rights Act
In 1998, the United States Department of Labor and Health and Human Services enacted the Women’s Health and Cancer Rights Act (WHCRA). The mandates of WHCRA apply to all group health plans that went into effect after October 1, 1998. It applies to Health Maintenance Organizations (HMO), private health insurance companies, and group health plans that offer benefits to cover a mastectomy.
The WHCRA further stipulates that all insurers offering mastectomy benefits provide coverage for the following:
Patients may have to pay a deductible or co-insurance for reconstructive surgery, but it must be the same that they would pay for any other type of medical procedure.
The Department of Labor and Health and Human Services will impose sanctions against any insurance provider that changes eligibility requirements in order to drop the patient. It also does not tolerate insurers making a lesser payment to medical providers for completing reconstructive surgery or offering them an incentive to refuse to do the surgery.
Breast Reconstruction Surgery and Medicaid Coverage
Medicaid is a federal health insurance program for low income individuals and families who meet the program’s requirements. It helps to pay for some or all healthcare costs for people who have limited resources. The Medicaid program is not included in the WHCRA of 1998. Coverage for breast reconstruction surgery after a mastectomy varies by state. Patients who wish to look up available benefits in their home state should visit the Medicaid website at http://www.medicaid.gov.
Get Help Understanding Insurance and Patient Financial Responsibility
Toni Conner is the contact person for patients of UPMC Western Maryland Plastic Surgery who have financial questions about their plastic or reconstructive surgical procedure. Her contact telephone number is 240-964-8931. While patients are responsible for understanding their insurance coverage, she can help to answer questions and provide additional resources for those who need to finance any part of their surgery.
What is the recovery time for breast implant removal
A breast implant removal procedure or an explant is a surgical procedure performed with the purpose of removing or replacing breast implants. If you no longer want implants or if your implant has ruptured an explant surgery or enbloc removal can help, Recovery after Breast Implant Removal can take up to six weeks. However, your final results may not be visible until up to a year after the procedure.
To ensure the best possible results, you need to take extreme care during the recovery period to allow proper healing of your breasts. It is highly recommended to follow these best tips from Dr Scott Turner, a Specialist Plastic Surgeon in Newcastle and Sydney NSW.
CLICK to Download Dr Scott Turner’s Surgery Recovery Guide
Removal of Implants & BII Symptoms
Another reason to undergo an explant procedure is a diagnosis of breast implant illness or BII. Breast implants can cause fatigue, headaches, bone aches, and body pains in some patients. If you are suffering from these symptoms, you may want to consult your doctor and look into an explant procedure. Many patients seek breast capsure removal at the same time, either Enbloc, total or partial capsulectomy. Many patients report relief from BII after Breast Implant removal and just partial capulectomy.
How to prepare for better recovery after Breast Implant Removal
To ensure optimal recovery, there are certain steps you need to take before even undergoing the procedure. This is because these steps set you on the fast track to a quicker and complication-free recovery period.
1. Quit smoking and reduce alcohol consumption
Both of these increase your risk of post-op complications, and you should quit smoking at least 6 to 8 weeks before the procedure.
2. Reduce some medications
Being on certain medications like blood thinners can put you at risk of bleeding either during or after the procedure. You should speak to your primary care physician to adjust the dosages of medicines that you must take, such that they don’t increase your chances of developing complications during the procedure or after.
3. Find someone to support and take care of you
Since you will be resting for a better part of the week and maybe experiencing slight discomfort, it is best to ask a friend or loved one to help take care of you. This is recommended because while performing your daily tasks, you may accidentally put pressure on your breasts and cause complications. A responsible person is also required to drive you home after the surgery.
5. Arrange a comfortable place in your house for recovery
Being comfortable after the procedure is important and you should prepare this place before you even go into surgery. Do the shopping and get everything you need.
Best Tips for a Better Recovery after Explant Surgery
The best tip for a smooth recovery period is to rest and take care of yourself, nourish your body while it heals itself. The following steps are recommended to ensure better recovery:
1. Stay hydrated
Drinking enough water is vital. It is mentioned here because not drinking enough water and dehydrating your skin, especially while it’s supposed to be healing from the incisions, may complicate the healing process.
2. Rest and Sleep well
Getting full eight hours of sleep during the recovery period helps your body be well-rested. This is mainly because our body heals itself while we sleep and depriving your body of sleep is equivalent to depriving your body of the chance to heal.
Moreover, you should sleep on your back, for at least two weeks post-op so as to not disturb the wound healing process. You should absolutely refrain from sleeping on your stomach as that will definitely complicate the healing process and impact the final result.
3. Manage your discomfort with prescribed medications
Your surgeon will prescribe pain killers and antibiotics, to help you manage your pain and reduce the risk of infection. You should take these medications as prescribed, especially the antibiotics, for the recommended period of time. An important note here is to avoid the consumption of alcohol while taking these antibiotics. In general, you shouldn’t be drinking while recovering but you should absolutely abstain from alcohol while taking antibiotics.
4. Refrain from exercising too much
Exercising should be avoided during the first 2 weeks of recovery. No form of exercise is allowed during this period because even the slightest pressure on the incisions could result in wound separation or a poor result. After two weeks, you can perform light exercises, basically, anything that doesn’t involve the chest region. After six weeks, you can resume your normal exercise regimen and training programs. Just avoid stress and straining early on.
5. Wear your compression garments as recommended
After surgery, fluid accumulation and swelling can occur, especially as there is an empty space or cavity. To manage these symptoms, you will need to wear a compression bra, for a minimum of two weeks, day and night. Not only will it help reduce the swelling but also keep your skin tight and prevent any distortion of the breast shape.
6. Keep dry! – Stay away from baths and pools
You should not shower the first day after the surgery, and during the next couple of days, a sponge bath may be the best choice of action for you. Till your incisions are healed, you should avoid baths, spas and poos completely, and take absolute care while showering to keep the incisions dry.
What to eat during the recovery after Breast Implant Removal
A well-balanced diet is needed to provide your body with the nutrition that it needs to heal and recover from the breast implant removal procedure. To obtain maximal benefits, you should eat the following foods:
At the same time, there are certain foods that you should reduce which include:
Exercising after Explant Surgery
When it comes to exercising after the implant removal surgery, it is highly recommended that you avoid exercising completely for at least the first two weeks of the recovery period. This is to allow the swelling, bruising, and discomfort to subside a little, and for your body to start the wound healing process.
After the first two weeks, you can start with your light exercises, anything that doesn’t put pressure on your breasts. During this period, your incisions are still in the healing phase, and any extra pressure on them could result in complications such as dehiscence or separation of the wound.
After six weeks, you can consult your surgeon or support team and resume your daily life activities, including exercises and training programs.
When should breast implants be removed?
For women with breast implants, it’s important to have them replaced usually between 10 to 15 years. While some women may choose to have a breast implant revision, replacing the implants with a different size or shape, some women choose breast implant removal, also called explant. If you’re considering this procedure, our Raleigh plastic surgeon is sharing a closer look at what you can expect from having your implants taken out.
What Does a Breast Implant Removal Procedure Involve?
Whether you’ve experienced a complication, such as painful scar tissue, or you’re simply ready to have them removed, the process is generally the same:
Once you’re in recovery, prior to leaving, you will be sent home with the appropriate compression garments (included in the cost of your surgery) and prescription medications as needed. Since you’ll be coming out of anesthesia and will be on pain medication, you’ll need someone to drive you home after your surgery and stay with you for at least 24 hours. We cannot let patients drive themselves home following surgery.
Initial Recovery After Having Implants Removed
The first few days after your surgery, make sure you stay on top of your pain medication to minimize discomfort. It’s important to take it easy, but still get up from time to time, like walking to the kitchen or the restroom, and sitting up. Most people are back to work after three or four days.
You’ll receive in-depth instruction for changing bandages, cleaning incision sites, showering, and other post-op activities, and it’s important to avoid taking baths, swimming, or using a hot tub for two weeks following surgery. You can shower the next day, though. While complications are extremely rare, Dr. Ortiz, or your plastic surgeon, will discuss how to minimize risk of infection and complications.
Long Term Recovery After Breast Implant Removal
It’s normal to experience soreness, tenderness, and sensitivity as you recover from your breast implant removal surgery for around six weeks. While you can go about your day fairly normally after three or four days following the procedure, it’s important to avoid the following activities for at least six weeks:
At around the six week mark, you’ll have a post-op appointment with your plastic surgeon who will clear you for exercise and other activities. Also, for about two to three weeks following the procedure, it’s important to wear a compression bra to allow tissues to shrink back and maintain the shape and lift of the breasts after the surgery.
What Kind of Results Can You Expect?
While every woman’s results are different, the shape and condition of how your breasts will look after explantation depends on the size of your breasts prior to augmentation, the size of the implants, and what kind of changes your body has gone through during the time you’ve had them. Weight loss or gain, pregnancy, and menopause all play a role in the size, shape, and elasticity of breast tissue and skin.
Women with smaller implants will likely experience less sagging and drooping, whereas larger implants may have stretched the skin, which can lead to more pronounced sagging. Additionally, older women or women who have gone through more significant weight and hormonal changes will have less collagen and elasticity to the skin, and thus will be less likely to “bounce back,” so to speak.
If you are having a larger implant removed or are concerned with drooping and sagging, a breast lift can be performed in conjunction with removal, so you can still feel confident in your body and appearance.