Private Health Insurance For Breast Reduction

Compare quotes for private health insurance that covers medically-necessary breast surgery through Savvy. 

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, updated on July 6th, 2023       

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We’ve partnered with Compare Club to bring you a range of health insurance policies to help you compare them side by side.

Are you considering the possibility of surgery for breast reduction or augmentation and wondering if private health insurance will help cover the cost? Medicare won’t cover these procedures unless there is a medical reason for needing them.  

You can find out what the Medicare rules are regarding medically-necessary breast surgery here with Savvy and compare policies for private health insurance which may be able to assist with the cost. Get free online quotes from a panel of some of Australia’s leading health insurers through us today.  

What type of health insurance covers medically-necessary breast reduction surgery?

If you qualify for medically-necessary breast reduction surgery, a private health insurance hospital cover policy can assist with the cost of the surgery. Coverage for this type of surgery is usually only available with silver or gold hospital cover policies. However, it’s important to check the exact details of the plan you're considering, as some health insurance policies don’t cover this type of surgery at all. 

Breast reduction surgery won’t be covered by Australia’s Medicare system if it’s undertaken purely for cosmetic reasons. However, there are many circumstances where breast reduction and augmentation surgery are considered medically necessary, most often following surgery for breast cancer or developmental abnormality. Other reasons may include: 

  • Back pain 
  • Neck and shoulder discomfort 
  • Headaches (particularly migraines) 
  • Breast hypertrophy (increase in density and weight of the breasts) 
  • Shortness of breath 
  • Numbness in the arms and fingers 
  • Re-occurrent skin infections and irritations 
  • Inability to participate in exercise or sporting activities 
  • Self-esteem and mental health issues caused by breast size 

Your doctor will need to provide documentation to your health fund to certify that your breast reduction is considered medically necessary. If the diagnosis is accepted, Medicare will pay a benefit amount towards the cost. Private health insurance can assist with additional costs which may not be covered by Medicare, such as gap fees charged by your surgeon or anaesthetist or day theatre fees if you have the procedure performed in a private hospital. Usually, breast reduction only requires a short stay in hospital, possibly one to two nights. 

Savvy can help you compare health insurance policies which may include cover for mammoplasty. All you need to do is fill in an online form and you can have a range of health insurance quotes to compare from our panel of insurers, including some of Australia’s top health funds

How much does medically-necessary breast reduction surgery cost in Australia?

Breast reduction surgery, or reduction mammoplasty, can cost anywhere between $7,000 and $20,000* in Australia, depending on whether surgery is necessary on one or both breasts. If surgery has been performed to remove a tumour in one breast, reduction surgery (or augmentation on the side which has been operated on) is often only required on one side to even up the dimensions of both breasts. The complexity of the procedure may also impact the cost of your surgery. 

An example of the costs charged for a bilateral breast reduction (both breasts), taken from a leading breast clinic in Victoria, are:* 

Item Full cost Estimated out-of-pocket cost
Initial consultation
$250
$180
Surgeon's fees
$12,000
$8,650
Anaesthetist's fees
$2,250
$1,950
Hospital excess
$0 - $750
$0 - $750

*All figures and quotes are correct as of April 2023. 

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Frequently asked questions about private health insurance for breast reduction

What criteria are applied by Medicare for determining if breast reduction is medically necessary?

If your doctor certifies that your breast reduction is medically necessary, you will also have to fulfil the following criteria in order to get a Medicare rebate: 

  • The surgery is considered necessary to treat pain 
  • Non-surgical procedures have been tried but haven’t worked
  • Symptoms have lasted at least six months 
If I get health insurance for my breast reduction, will there be any waiting periods?

Yes – there may well be waiting periods that apply before you can make a claim on your health insurance hospital policy. The length of time that you may have to wait will depend on the level of private health cover that you’ve previously had and the tier of cover you may move up to. However, as a pre-existing condition on its own, breast reduction can come with a waiting period of 12 months.

How do I compare health insurance policies that will cover some of the cost of breast reduction surgery?

Some aspects of private hospital cover to compare when looking at policies side-by-side include:

  • Cost of the policy – how much you’ll pay in premiums each month 
  • Coverage – exactly what the policy covers, and any exclusions there may be 
  • Excess – make sure you're comparing health cover at the same level and with a similar excess, such as a silver policy with a $250 excess with another silver policy with a $250 excess. This will ensure you are comparing policies that offer a very similar level of coverage 
  • Co-payments – check if any co-payments are required for hospital admission. These co-payments can be up to $100 a night.  
What expenses can an extras policy cover after I have breast reduction surgery?

If you also have extras cover, some of the costs of receiving outpatient treatment may be covered by your extras policy. These could include:  

  • physiotherapy to aid with scar healing 
  • nutritional advice to help keep your weight down 
  • visits to a chiropractor to assist with musculoskeletal positioning as your body adapts to less weight on your chest 

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