Does job-based or Marketplace insurance cover breast reconstruction?

Yes, required by federal law when your plan covers mastectomies. Under the Women’s Health and Cancer Rights Act, plans that cover mastectomies must cover breast reconstruction, surgery on the other breast for symmetry, prostheses, and treatment of complications such as lymphedema, at any time after the mastectomy. Cost: Normal surgical cost sharing; it can’t be higher than for other benefits.

Does Original Medicare cover breast reconstruction?

Yes, Medicare covers reconstruction after a mastectomy. Medicare covers breast reconstruction after a mastectomy for cancer, and Part B covers external breast prostheses, including post-surgical bras. Cost: Generally 20% of the Medicare-approved amount after the Part B deductible.

Does Medicare Advantage cover breast reconstruction?

Yes, Medicare covers reconstruction after a mastectomy. Medicare covers breast reconstruction after a mastectomy for cancer, and Part B covers external breast prostheses, including post-surgical bras. Medicare Advantage plans must cover this too, but set their own copays and often require in-network providers and prior authorization. Cost: Your plan’s copay or coinsurance: check the Evidence of Coverage.

Does Medicaid cover breast reconstruction?

Yes, covered after a mastectomy. State Medicaid programs cover reconstruction after a medically necessary mastectomy.

Is breast reconstruction covered by insurance?

Reconstruction, symmetry surgery, and prostheses after a mastectomy. Here’s how each kind of plan usually handles it.

Ask a specific question Plan a visit: cost and doctors Check it against my plan

Employer or MarketplaceUsually covered
Yes, required by federal law when your plan covers mastectomies.
More details
Under the Women’s Health and Cancer Rights Act, plans that cover mastectomies must cover breast reconstruction, surgery on the other breast for symmetry, prostheses, and treatment of complications such as lymphedema, at any time after the mastectomy.
Cost: Normal surgical cost sharing; it can’t be higher than for other benefits.
Original MedicareUsually covered
Yes, Medicare covers reconstruction after a mastectomy.
More details
Medicare covers breast reconstruction after a mastectomy for cancer, and covers external breast prostheses, including post-surgical bras.
Cost: Generally 20% of the Medicare-approved amount after the Part B deductible.
Medicare AdvantageUsually covered
Yes, Medicare covers reconstruction after a mastectomy.
More details
Medicare covers breast reconstruction after a mastectomy for cancer, and covers external breast prostheses, including post-surgical bras. plans must cover this too, but set their own copays and often require in-network providers and prior authorization.
Cost: Your plan’s copay or coinsurance: check the Evidence of Coverage.
MedicaidUsually covered
Yes, covered after a mastectomy.
More details
State Medicaid programs cover reconstruction after a medically necessary mastectomy.

Plan type	How it’s usually covered
Employer or MarketplaceUsually covered	Yes, required by federal law when your plan covers mastectomies. Under the Women’s Health and Cancer Rights Act, plans that cover mastectomies must cover breast reconstruction, surgery on the other breast for symmetry, prostheses, and treatment of complications such as lymphedema, at any time after the mastectomy. Cost: Normal surgical cost sharing; it can’t be higher than for other benefits.
Original MedicareUsually covered	Yes, Medicare covers reconstruction after a mastectomy. Medicare covers breast reconstruction after a mastectomy for cancer, and covers external breast prostheses, including post-surgical bras. Cost: Generally 20% of the Medicare-approved amount after the Part B deductible.
Medicare AdvantageUsually covered	Yes, Medicare covers reconstruction after a mastectomy. Medicare covers breast reconstruction after a mastectomy for cancer, and covers external breast prostheses, including post-surgical bras. plans must cover this too, but set their own copays and often require in-network providers and prior authorization. Cost: Your plan’s copay or coinsurance: check the Evidence of Coverage.
MedicaidUsually covered	Yes, covered after a mastectomy. State Medicaid programs cover reconstruction after a medically necessary mastectomy.

What usually has to be true

Follows a covered mastectomy.
Prior authorization is common for the surgery.

Good to know

There’s no deadline: reconstruction is covered even years after the mastectomy.

Cancer treatment · Chemotherapy, radiation, immunotherapy, and oncology care.
Surgery · Inpatient or same-day surgical procedures.
Prosthetics & orthotics · Artificial limbs, braces, and prosthetic devices.

Sources

Typical rules for 2026 plans, checked against these sources on October 20, 2026. Your plan’s own documents decide.

1
Women’s Health and Cancer Rights Act
U.S. Department of Labor
Plans that cover mastectomies must also cover reconstruction of the breast, surgery on the other breast for a symmetrical appearance, prostheses, and treatment of physical complications, including lymphedema.
2
Prosthetic devices
Medicare.gov
Part B covers prosthetic devices that replace an internal body part or function, plus artificial limbs and eyes; you pay 20% after the deductible.
3
Surgery
Medicare.gov
Medicare covers medically necessary surgery; inpatient surgery falls under Part A and outpatient surgery under Part B.
4
Compare Original Medicare and Medicare Advantage
Medicare.gov
Medicare Advantage plans cover everything Original Medicare covers (except hospice, which Original Medicare continues to pay), usually use provider networks, often require referrals or prior authorization, and may offer extra benefits such as dental, vision, and hearing.
5
Mandatory and optional Medicaid benefits
Medicaid.gov
States must cover mandatory benefits such as inpatient and outpatient hospital care, physician services, laboratory and X-ray services, home health, and nursing facility care; many other benefits, including adult dental, vision, and prescription drugs coverage details, are state options.

General information about how coverage usually works, not a decision about your plan. Your plan documents and insurer have the final word.

Is breast reconstruction covered by insurance?

What usually has to be true

Good to know

Related

Sources