Will Medicare fund my breast reduction?

Breast Reduction / Medicare

31 Oct 2023

Will Medicare fund my breast reduction?

Are your large breasts causing you back and shoulder or neck pain? Are you finding yourself Googling, “Will Medicare help pay for my breast reduction in Australia?” or “How much does a breast reduction in Newcastle cost?”

It can be tricky to find an answer because most clinics choose not to publicly display their prices.

However, we understand breast reduction procedures in Newcastle cost around $15,000 to $30,000.

Why the big price range?

At Hunter Plastic Surgery, we are the only plastic surgery practice in the Hunter which outlines our fees publicly and with the total costs (not just a surgeons fee and expecting you to add up other costs like for the hospital and anaesthetist). We want our patients to understand all the likely costs before committing valuable time and money to a consultation.

  • For a privately insured patient, seeking a standard reduction, the total out-of-pocket cost is $18,000 or from $20,000 for larger cases or when combined with liposuction which takes additional theatre time (generally appropriate for larger body types). This total out-of-pocket cost include the surgeon’s fee, hospital, garment, anaesthetist and after care.

What about the average cost of breast reduction without insurance?

  • For patients without insurance, the total out-of-pocket fees start at $25,000. This total cost includes the surgeon’s fee, anaesthetist’s fee, hospital stay, after care and garment.

Will Medicare help fund breast reductions?

Yes if you meet the criteria outlined below. The rebate itself is around $1000 but importantly, you must be entitled to the Medicare number to ensure that your private health insurance to kick in.

The Medicare item number to check with your health fund is 45523. Not all policies will cover this item, so you may consider a change to your cover or even fund.

It is important to demonstrate clinical need, including pain in the neck and/or shoulder region. While consulting with your GP, it is worth discussing these symptoms to ensure the clinical need is documented in your referral for surgery which makes it easier for me to determine your eligibility for the Medicare item number.

For more details on our fees and the criteria Medicare use to determine if you can have a rebate, you can visit our breast reduction page.

Can I have a breast reduction done in the public system?

We understand there is currently very limited NSW public training hospital budget for breast reductions. This can vary in individual hospitals and over time, so it is worth checking with the NSW Government Surgery Access Line on 1800 053 456 to see if there is a provider near you.

Do we ‘no-gap’ breast reductions?

The ‘no-gap’ system is where the surgeon agrees to take a fixed fee from a private health insurer. While this can seem a positive for patients, in reality the fee the fund pays is simply not enough to run a modern plastic surgery practice like ours which is focused on exceptional clinical outcomes and award-winning care. In some cases, the no-gap fee is less than 40% of the scheduled fee set by the Australian Medical Association. Sadly some providers choose to use this system while also charging a patient a gap which is not disclosed to the fund – this is unethical and breaches the health fund contracts.

We prefer to be up-front and provide the total costs in a transparent way for you to make informed decisions about the costs vs potential outcomes.

What should you ask when you are considering your options?

These are some questions you might like to ask when looking at different options. My answers apply to the following:

  • Is this surgeon a genuine Plastic Surgeon? Understanding this question is crucial. This means have they completed at least 14 years of training and examinations, or even more as I invested 17 years in my training and fellowship. This contrasts with the term ‘cosmetic surgeon’ which anyone with a basic medical degree can get.
  • Will you be operated on in a fully accredited hospital? Yes.
  • Will a Specialist Anaesthetist administer you a full general anaesthetic? Yes.
  • How many of this type of procedure has the surgeon performed? Over 1,000 women in Newcastle.
  • Can you view lots of before and after clinical photos? Yes – on this website and on social media.
  • How well are the risks and recovery process explained? We have information on our website, as well as comprehensive information provided during your consultation and to take home to consider afterwards.
  • Are there after care services offered? All patients see both my Practice Nurse Alecia for post-operative support and myself for ensuring support throughout your recovery. It is our focus on patient care that has seen us win 25 awards for our service since founding in 2009.

‘Try before you buy’ with a $100 Vectra 3D photo simulation.

To explore what a breast reduction may look like on your own body, you can book a $100 Vectra 3D surgery simulation with our Practice Manager Jessica (which is rebated against my consultation fee). This service is ideal for small to moderate reduction patients.

For very large breasts the simulation is less accurate but the appointment gives you the opportunity to talk to Jessica about the surgical process, costs, choice of hospital and review of previous patient case studies.

Find more information on the website

Discover more about breast reductions (also known by the medical term of reduction mammaplasty), including information on costs, hospital arrangements, recovery and also a 3D animation of the procedure by visiting our breast reduction page.

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Blog Author:

Dr Nicholas Moncrieff, Specialist Plastic Surgeon, Newcastle NSW

About Dr Moncrieff

Dr Moncrieff focuses exclusively on breast reductions, breast lifts, breast augmentation, tummy tucks and body lifts.

He is one of only a handful of Plastic Surgeons across Australia with this sole breast and body focus.

Dr Moncrieff has performed thousands of surgical procedures over more than two decades in medicine. Over 20,000 of these procedures have been in Newcastle.

More information about Dr Moncrieff is available here.

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