Are your large breasts causing you neck or shoulder pain or making it uncomfortable to exercise?
If you're thinking about a breast reduction in Newcastle, you might be wondering if Medicare will help with the cost. The good news is that it can, but only if you meet strict eligibility criteria. Here’s what you need to know about the Medicare rules for breast reduction.
Will Medicare help fund breast reductions in Australia?
Yes, Medicare will assist with the cost of breast reduction surgery if it is deemed medically necessary. This means your surgery must address specific health concerns rather than being purely cosmetic.
Who is eligible for a Medicare rebate for a breast reduction?
To qualify, your breast reduction MUST meet the following conditions:
- You experience chronic pain in your neck or shoulders due to the excessive size or weight of your breasts.
- You are not seeking to have an implant added to you breasts at the same time.
It is also very USEFUL if you can demonstrate that:
- You have persistent skin infections or rashes under your breasts.
- Your breast size significantly impacts your daily life, such as you have difficulty exercising.
How much will being eligible for a Medicare rebate save me?
For a patient without private health insurance: Medicare coverage means a rebate of around $1000.
For an insured patient, being eligible for a Medicare item number can reduce the cost by around $5000 or more!
The Medicare item number to check with your private health fund is 45523. Not all policies will cover this item, so you may consider a change to your cover or even your fund.
For more details on our fees, you can visit our breast reduction page.
How to apply for a Medicare rebate for a breast reduction
- Visit your GP – Discuss your symptoms and request a referral to a specialist with a letter that demonstrates all your symptoms and medical concerns.
- Consult a plastic surgeon – Your surgeon will assess whether you meet Medicare’s criteria.
- Check your private health coverage – Contact your insurer to understand what costs are covered.
- Submit a claim after surgery – After the procedure, submit your Medicare claim for a rebate of eligible costs. Find our step-by-step guide on how to process your Medicare claim here.
Can I have a breast reduction fully-funded by Medicare?
You may be eligible for a breast reduction in the public hospital system however there is very limited access and long wait lists. It is worth checking with the NSW Government Surgery Access Line on 1800 053 456 to see if there is a provider near you.
Why is Hunter Plastic Surgery worth considering for your breast reduction?
My exclusive focus is breast and body surgery and I’ve performed thousands of breast reductions in Newcastle since 2009. Our clinic is multi-award winning for our patient care and results with a safety focus.
‘Try before you buy’ with a $100 Vectra 3D photo simulation.
To discuss your eligibility for Medicare assistance and 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.
Next steps
If you’re ready to explore more about breast reduction surgery, contact us today to schedule an appointment or even just chat to our team about the process. We’ll help you understand your options and guide you through the Medicare process. Call (02) 4920 7700 or you can send us a message using the contact form on the bottom of this page.
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, his award winning results and care is available here.
