There are four options following a mastectomy: breast reconstruction, off-the-shelf breast prosthesis, custom breast prosthesis, or go flat. Currently, Medicare does not cover custom breast prostheses, limiting choice for women undergoing breast cancer treatment and recovery.
Provide coverage for custom breast prosthesis following mastectomy.
Why Is it Needed?
- Following passage of the Women’s Health and Cancer Rights Act of 1998 (Public Law 105–277; 42 U.S.C. 201), many private insurers and group health plans began to provide coverage for custom, fabricated breast prostheses as an alternative to surgical breast reconstruction.
- Currently, the Medicare program provides coverage and reimbursement for custom fabricated prostheses for any body part that has been lost—with the exception of the breast.
- Because the Medicare program does not provide reimbursement for custom fabricated breast prostheses, many private insurance companies have also begun to limit their reimbursement for them.
- Like all surgeries, reconstructive surgery has risks, and not all women qualify due to medical history or diagnosis.
- Off-the-shelf prostheses are not available in all skin tones or breast sizes and may not comfortably fit the post-surgical area.
- Older and minority women are less likely to undergo reconstructive surgery and have less access to custom prosthesis.
Did You Know?
What happens next? Because many health insurance companies follow Medicare guidelines, it’s important that this legislation pass, so women have the choice of the post-mastectomy solution that works best for them.