Will Medicare help fund my mummy makeover?

Breast Augmentation / Breast Reduction / Tummy Tucks / Breast Lift / Mummy Makeover / Medicare / Financing

1 Jun 2021

medicare rebate on mummy makeovers

Has your body changed after pregnancy? Have you been battling with excess skin and muscle separation, or deflated breasts after breastfeeding? Will Medicare assist with a mummy makeover? Read on to find out!

What is a mummy makeover?

The term ‘mummy makeover’ generally refers to the combination of breast surgery and a tummy tuck surgery for women looking to restore their body post-pregnancy. We see many patients who love being mums, but struggle with painful symptoms or simply don’t feel connected to their postpartum bodies. This is where we come in!

What does a mummy makeover with Dr Moncrieff cost?

As a guide, the combination of breast and body surgery starts at $30,000. Please see our mummy makeover page for full out of pocket cost details for both insured and uninsured patients seeking a tummy tuck and breast reductions, lifts or augmentation.

Can I get a Medicare rebate on my mummy makeover?

Yes – depending on which particular procedures you wish to undergo and your need for surgery. This is where is gets tricky.

Breast reductions and breast lifts are both procedures that may be eligible for a Medicare rebate. In majority of cases, breast augmentation does not attract a Medicare rebate.

In 2016 the Government ended support for women with muscle separation post pregnancy by removing access to the relevant Medicare item number for abdominoplasty and restricting it only to mass weight loss patients. What this means is that Medicare will provide a modest rebate for a tummy tuck, only if you satisfy this weight loss criteria.

What do I have to demonstrate to get a Medicare number for a tummy tuck?

For the Medicare item number 30177 to apply you must demonstrate:

  • That you have had significant weight loss defined as 5 BMI points or more (unrelated to pregnancy). This mean women who have experienced a weight loss of at least 15kgs or more, without weight fluctuations for at least 6 months,
  • The level of excess skin is interfering with daily living,
  • The use of non-surgical treatment for skin irritation caused by excess skin has failed to work,

For more details on the Medicare criteria used to determine if you can have a rebate for a tummy tuck, visit our blog post HERE.

What about a breast reduction or lift?

For the Medicare item number 45523 to apply for breast reduction, you must demonstrate clinical need, including:

  • Macromastia (disproportionately large breasts)
  • Back, neck or shoulder pain in relation to the breasts

And for the Medicare item number 45558 to apply for a breast lift, you must demonstrate:

  • Breast ptosis with at least two-thirds of the breast tissue, including the nipple, falling below the breast fold
  • That you have a child between the age of 1-7

Most importantly, meeting the necessary Medicare criteria is key to having health fund coverage, which can reduce the overall out of pocket cost of a tummy tuck and breast reduction/lift from $42,000 to $32,000. 

All of the above should be discussed with your referring GP and documented in their referral to us. If you provide a referral, Medicare will provide you with a rebate of just over $75 from our initial consultation fee of $350.

What if my health fund covers me for the breast portion of my surgery, but not the tummy tuck?

If you do not meet the Medicare criteria for a tummy tuck, or your level of private health insurance does not cover one, they will generally not cover the breast surgery either. This is because the health funds may view the tummy tuck as the primary component of the surgery, meaning they may refuse to cover the cost of your hospital stay and theatre fees, even if they would otherwise cover a breast reduction or lift.

What if I haven’t had weight loss?

Unfortunately, the Medicare rules don’t currently provide assistance for women suffering from muscle separation or excess skin relating to pregnancy. We have lobbied hard against this unfair rule! We even contributed to a national study published in 2018 that demonstrated the significant improvements in back pain and incontinence for women who had muscle separation which was repaired during their tummy tuck. More information about our fight for mums can be found HERE.

Ready to book a consultation?

Please call our lovely team on 4920 7700 or send us a message below. We also have two team members who had mummy makeovers with Dr Moncrieff before they applied for roles with us who are happy to talk you through the surgical journey!

Other blogs you may be interested in:

Practice Manager Jessica Laing

Blog Author:

Jessica Laing, Practice Manager, Hunter Plastic Surgery

About Jessica

Jessica joined our team in 2010 and has worked very closely with Dr Moncrieff as Patient Manager and then Practice Manager since 2015. 

Her commitment and care for patients is legendary. She has even won awards for her focus on service including at the 2020 Stevie Global Sales and Customer Service Awards as Young Customer Service Professional of the Year, as the Australasian Practice Manager of the Year at the 2019 MyFaceMyBody Global Awards and at the 2017 Lake Macquarie Business Excellence Awards.

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