Breast reduction surgery is partially covered by Medicare and may be covered by private health insurance.
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Medically necessary breast reduction can be covered by Medicare and private hospital cover.
Depending on the situation, public surgery wait times could be over a year or more.
Even with private health cover, out of pocket costs could be seveal thousand dollars.
How much does breast reduction surgery cost?
The cost of a breast reduction varies depending on the type and reason for the surgery. In the private system, without insurance, a unilateral breast reduction $10,000. This surgery is normally done on a healthy breast after a cancer is removed from the other breast, to even them up. A bilateral breast reduction can cost closer to $15,000 - these surgeries are done for a range of other medical reasons.
If you have private hospital insurance that covers breast surgery, you'll be able to get some of that private surgery covered. According to Medical Costs Finder, the typical out of pocket payment is around $1,000 for unilateral procedures, but around $8,400 for bilateral procedures.
Does Medicare cover breast reduction surgery?
Medicare will cover medical breast reduction surgery in a public hospital, so you won't have anything to pay out of your own pocket. Unfortunately, breast reduction is often categorised in one of the lower priority surgery categories, so you could be waiting over a year for surgery. The medical reasons for your surgery could affect your prioritisation category.
How does private health insurance cover breast reduction?
Breast surgery is covered under Bronze tier hospital policies. If you are covered and need surgery it will cover some, but not all, or your treatment costs. Exactly how much you'll have to pay for your breast reduction will depend on the reason for the surgery, whether or not it is unilateral or bilateral, as well as your private health fund's gap payment arrangements.
To reduce your our of pocket costs, you should call your health fund before the surgery is booked in. This will let them explain how the gap payment works, and if there are any ways you can reduce the gap, such as getting the work done at one of their agreement hospitals.
In order to receive cover for the procedure, Medicare will need to deem it medically necessary. Breast reduction surgery conducted for purely cosmetic purposes isn't covered by your health fund.
It’s also worth noting that any health problem that needs to be alleviated by breast reduction surgery will likely be classed as a pre-existing condition by your health fund, so you will need to serve a 12-month waiting period before you will be eligible to receive any benefits.
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Under 65
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*Prices updated March 2024, in line with Finder's
database of health insurance policies. Prices are based
on a single individual with less than $93,000 income and
living in Sydney with a $750 excess.
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Comparing quotes from 40+ funds...
Signs that a breast reduction might be right for you
Medical reasons for breast reduction surgery include:
Back pain and backaches
Neck pain
Shoulder pain
Migraine headaches
Shortness of breath
Numbness in the hands and fingers
Skin irritations
If you suffer from any of the above symptoms, breast reduction surgery could be beneficial for you.
However, the procedure does come with a number of risks attached and it’s important that you’re aware of them before going under the knife.
What’s involved in breast reduction surgery?
Breast reduction surgery, which is also commonly referred to as reduction mammaplasty, involves cutting and removing excess fat and glandular tissue from the breast, repositioning the nipple and areola higher on the breast and removing the excess skin. This makes the breasts smaller and lighter. The aim of the surgery is to produce breasts of a size and shape that are in proportion to the rest of the patient’s body.
However, it’s worth pointing out that it is recommended that you wait until your breasts are fully developed and childbirth and breastfeeding have been completed before undergoing the procedure. Your ability to breastfeed following breast reduction surgery may be harmed and changes to your breasts while pregnant can also alter the results of previously completed surgery.
Finder survey: Which conditions have Australians made a hospital claim for?
Response
Female
Breast surgery
1.72%
Source: Finder survey by Pure Profile of 1006 Australians, December 2023
Making a claim
If you’re planning on undergoing breast reduction surgery and need to know whether you’ll be covered, you’ll first need to find out whether the procedure will be deemed medically necessary by Medicare and therefore eligible for a benefit.
You will also need to provide details of the procedure to your health fund to determine whether or not you are eligible for cover. This usually involves filling out a medical estimate form with information on your surgeon, anaesthetist, procedure (including MBS item numbers) and the hospital where you will be treated. Your fund will then be able to tell you whether or not you will be covered and to what level.
Frequently asked questions about breast reductions
There is no guarantee that you will be able to breastfeed after the procedure is completed.
This is highly unlikely, but putting on a significant amount of weight will cause your breasts to enlarge.
Yes, the procedure is almost always done with the patient is under general anaesthesia.
Yes, scars are an inevitable result of this type of surgery. However, your surgeon will make every effort possible to minimise scarring.
Yes, breast reduction surgery is an inpatient procedure.
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To make sure you get accurate and helpful information, this guide has been edited by Peta Taylor as part of our fact-checking process.
Tim Bennett is a Finder insurance & utilities expert. For over 10 years he's reported on news, politics, finance and other topics as a journalist and radio presenter. Tim's roles have included radio news reader and breakfast at the ABC, news producer for SBS and producer for Fairfax Media. Tim regularly appears as a health insurance expert on programs like Sunrise and SBS news, as well as in the Australian, The Daily Telegraph, The Courier Mail and more. See full bio
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Depending on your age, you may be eligible for an
aged-based discount. This is used to estimate your
rebate.
Under 65
65 - 69
70 or older
What's your household's taxable income?
This is the combined income you and your spouse earn before tax. It's needed to calculate the correct Australian government rebate.
$93,000 and under
$93,001 to $108,000
$108,001 to $144,000
$144,001 and over
What kind of health insurance do you need?
Combined (Extras + Hospitals)
Extras
Hospital
What level of hospital coverage would you like?
You can change this at any time later.
Legend
Covered
Restricted cover, You may be partially covered for
this category.
Not covered. Optional for insurer to include.
*Prices updated March 2024, in line with Finder's
database of health insurance policies. Prices are based
on a single individual with less than $93,000 income and
living in Sydney with a $750 excess.
What extras cover do you need? (Optional)
Select as many as you want or move to the next step
Preventative & general dental
Major dental & implants
Optical
Physiotherapy
Podiatry
Non-PBS pharmaceuticals
Chiropractic
Emergency ambulance
Remedial massage
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