S 562/HR 1370

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.

The Goal

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?

  • There are more than 3.5 million women with a history of breast cancer in the United States.
  • In 2018, more than 260,000 women were diagnosed with invasive breast cancer that required surgery.
  • 144,000 women in the U.S. undergo mastectomies each year.
  • In 2019, more than 40,000 women are expected to die from breast cancer.
  • #LetHerDecide
    The introduction of the Breast Cancer Patient Equity Act was an initiative of Essentially Women and People for Quality Care, divisions of VGM Group, Inc., through the #letherdecide campaign.

    The #letherdecide campaign educates women on their options following a mastectomy and provides links for contacting lawmakers in order to promote the legislation.

    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.

    For additional information, visit letherdecide.org and congress.gov.