Can Insurance Cover Breast Reduction – Factors Affecting the Cost of Breast Reduction

Can insurance cover breast reduction? If you’re thinking about getting a breast reduction, you probably want to know how much it will cost and if your insurance will pay for it. Coverage is not available for breast reduction surgery performed for aesthetic purposes.

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However, your health insurance might pay for the procedure if you’re having it done for medical reasons. Certain requirements must be met for your insurance to fund a breast reduction. Continue reading for more information about breast reduction surgery costs and when insurance will cover them.

Can Insurance Cover Breast Reduction

What is Breast Reduction?

Breast reduction is a surgical procedure that involves removing skin and tissue from the breast and then reshaping and elevating it, to achieve a smaller, more proportionate bust size.

Although many women find it difficult to decide to have a breast reduction, in the end, they think it is one of the best things they have ever done for themselves.

Why get Breast Reduction?

There are several drawbacks to having huge breasts, despite what some people may not realize. Pain in the neck, shoulders, and back resulting from the additional strain the enlarged breasts exert on the musculoskeletal system can be one of the symptoms.

Breast soreness and dermatitis, or rashes under the breasts from the skin’s continual contact, are a few less frequent symptoms. There are psychological drawbacks, such as low self-esteem due to one’s enormous breasts, limited exercise, and trouble dressing or finding bras that fit.

Any age is appropriate for breast reduction surgery, even adolescence. However, you might need a second surgery later in life if you have breast reduction surgery before your breasts are fully formed. Because of these factors, a large number of people experiencing similar symptoms think that breast reduction surgery is always required and will be paid for by insurance.

How Much Does Breast Reduction Cost with Insurance?

The most recent data from the American Society of Plastic Surgeons shows that the average cost of breast reduction (for those undergoing aesthetic procedures only) is $6,771.  The average surgeon’s fee is only a portion of the whole cost; anesthesia, operating room supplies, and other associated costs are not included.

Factors Affecting the Cost of Breast Reduction

The following factors affect the rate:

  • The surgeon’s level of experience.
  • The breast reduction technique.
  • Whether the surgery will be on one or both breasts.
  • The location.
  • Board certification.

These are some of the factors that influence the cost.

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Best Companies that Offer Insurance for Breast Reduction

Some insurance companies that cover breast reduction include:

  • Blue Cross Blue Shield.
  • Cigna.
  • Humana.
  • Aetna.
  • Cigna.
  • UnitedHealthcare.

These are some companies that offer coverage for this medical procedure.

When is Breast Reduction Covered by Insurance?

Some of the conditions an applicant for a breast reduction must satisfy (and her physician must record) to be eligible for insurance coverage include:

  • Chronic back, neck, and shoulder pain.
  • Abnormal curvature in the spine.
  • Tingling or numbness in the upper extremities.
  • Deep notches in your shoulder from tight-fitting bra straps.
  • Migraine headaches.
  • Shortness of breath.

Your doctor may need to provide information to the insurance provider to support your claim.

How to Obtain Insurance for Breast Reduction

Take the steps indicated below to receive this insurance:

  • Visit the official websites of the insurance companies (Blue Cross Blue Shield, Aetna, Humana, Cigna, etc.) that were previously listed.
  • You can visit the Cigna official website at https://www.cigna.com/
  • All you have to do is scroll down the page to find their contact information.

Give them a call for further details on how to put this policy into effect.

Frequently Asked Questions

Below are some frequently asked questions.

Does Breast Reduction Get Covered by Health Insurance?

The patient’s rationale for selecting a breast reduction will determine the response to this question. If a doctor recommends breast reduction surgery to cure persistent physical or psychological problems, health insurance will pay for the procedure. However, your case will be classified as cosmetic if it does not fit the requirements for a surgery that is medically required, and the insurance company will be entitled to reject the claim.

What is the Duration of Recuperation After Breast Reduction?

Overall, it may take up to six weeks following the procedure before you start to return to your regular schedule, and during this time you might require assistance with errands or shopping.

Will my Breast Reduction Leave Scars?

After breast reduction surgery, your nipples will most likely be scarred. There may be a horizontal scar across the crease behind your breast and a vertical scar running down your breast.


Health insurance will pay for breast reduction surgery if it is deemed medically essential. It might be difficult to prove medical necessity to your insurer, and your healthcare practitioner may need to produce a lot of paperwork in this regard. Those without insurance or those who desire the reduction for cosmetic purposes will be responsible for covering the whole cost out of pocket.