Breast reduction surgery costs
Are you considering a breast reduction surgery? The last thing you want to worry about is the cost. Give us a call and one of our health insurance experts can help you look for a policy that gives you peace of mind today.
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How does a breast reduction surgery work?
A reduction mammaplasty, commonly referred to as a breast reduction, is a surgical procedure usually performed by a specialist plastic surgeon to remove excess breast tissue, glandular tissue, and skin to reduce the size of your breast.1
This procedure can be undertaken for cosmetic reasons, or due to back pain and neck pain that may be caused by large breasts. As with all plastic surgery, a breast reduction must be undertaken in an accredited hospital or day surgery.
This surgery involves going under general anaesthetic and is often undertaken alongside other types of breast augmentation such as such as breast lifts (mastopexy), areola reshaping and repositioning, and changes to the breast shape to fix asymmetry. However, these additional procedures may not be covered by Medicare or your health fund.
What is gynecomastia and how is it treated?
Gynecomastia is a very common condition in males, characterised by an increase in breast tissue, typically due to a hormone imbalance, an underlying illness, or medication.2 More than half of all young males develop this condition during puberty, with most cases subsiding as they grow older.
Generally, this is not a serious condition, and it can be treated through lifestyle changes, adjusting your medication, or treating an underlying disease. However, if you experience any pain or swelling, or notice a lump or any discharge, it’s important to talk to a doctor.
In some cases, severe gynecomastia can be treated through surgery. This surgery is slightly different from a breast reduction, as it removes all of the breast tissue, instead of just a portion of it.
Private health insurance for breast surgeries
Breast reduction surgery costs with health insurance
When you’re treated in a private hospital for a medically necessary breast reduction surgery with an associated Medicare Benefits Schedule (MBS) item number, Medicare rebates 75% of the MBS doctors’ fees.
If you have a sufficient level of hospital cover and have served the required waiting periods, your private health fund will pay at least the remaining 25% of the MBS fee and some or all of your hospital fees. If your anaesthetist and surgeon’s fees are above the MBS amount, the difference is called the gap. This amount could be paid in full or reduced by your fund’s gap cover scheme, otherwise you will be responsible for paying this cost.
In 2022-23, the average amount paid out-of-pocket by an Australian patient for a medically necessary breast reduction surgery in a private setting was $8,400.3 While that might seem like a lot, if we exclude the average private health contribution ($610 for doctors’ fees, $3,600 for hospital fees), the average cost could be as high as $12,000.
Shopping around for an affordable doctor and a health fund with a good gap cover scheme can offer significant savings. Despite the high cost of this surgery, 4% of Australian breast reduction surgery patients were treated with no gap.
Gynecomastia surgery costs with health insurance
Like a breast reduction, when you’re admitted to a private hospital for a medically necessary gynecomastia surgery, Medicare and your private health insurance work together to pay the full MBS fee for your doctors, and your health insurance will pay some or all of the costs for your hospital stay.
As this is usually a simpler procedure, the cost of a gynecomastia surgery is typically lower than a breast reduction, with private patients paying an average of $3,700 for their surgery in a private hospital.4 The typical amount paid by private health insurance for this procedure was $500 for the doctors’ fees and $2,700 for the hospital fees.
Breast reduction surgery and health insurance
Waiting periods
Before you can claim on your private health insurance for a breast surgery, you’ll need to serve your waiting period. All treatments under the breast surgery clinical category and the plastic and reconstructive surgery (medically necessary) clinical category come with a two-month waiting period, or twelve-month waiting period if the condition is deemed to be pre-existing. This means you’ll need to wait that long after taking out cover before having a procedure and claiming a benefit.
If you’re already covered for breast surgery and choose to switch health funds, your waiting periods can be transferred across, so you won’t have to serve them again.
Out-of-pocket costs
Besides the gap, you may also be required to pay some other out-of-pocket cost when you’re admitted as a private patient to a public or private hospital and choose to claim on your insurance. These costs are:
- Excess. This is an amount you pay when you are admitted to the hospital. Depending on your policy, you may only have to pay this amount for the first admission of the year. On some policies, you can increase this amount to lower your premiums and vice versa.
- Co-payment. If your policy includes a co-payment, this is an amount that you’ll be required to pay each day during your hospital admission. Co-payments are typically capped at a set number of days, so in these cases you won’t have to worry about paying indefinitely.
Some policies may have both an excess and a co-payment, so it is important to understand what you will be required to pay when having a procedure.
Are breast reduction and gynecomastia surgery covered by Medicare?
Yes, Medicare covers eligible patients for medically necessary breast reduction and gynecomastia surgery as a public patient. This includes all your doctor and hospital fees and any post-operative care. Medicare can also pay some of your costs as a private patient. However, they may not cover medically unnecessary breast augmentations that sometimes take place alongside a reduction.
If you want a cosmetic procedure, this will not be covered by Medicare or private health insurance, as you won’t be able to get a referral. You can still get some cosmetic procedures in a private hospital, but you will be responsible for the full costs.
While Medicare can cover almost all your medically necessary breast reduction surgery costs through the public health system, its biggest downside is the public waiting lists. Because treatment in the public system is prioritised by need, you could find yourself waiting a significant amount of time, depending on how urgent your need for surgery is deemed to be.. This could mean spending years suffering from back pain while you wait for your reduction.
Meet our health insurance expert, Steven Spicer
As the Executive General Manager of Health, Life and Energy, Steven Spicer is a strong believer in the benefits of private cover and knows just how valuable the peace of mind that comes with cover can be. He is passionate about demystifying the health insurance industry and advocates for the benefits of comparison when it comes to saving money on your premiums.
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1 Health direct – Breast reduction. Updated September 2023. Accessed 8 August 2024.
2 Health direct – Gynaecomastia. Updated July 2023. Accessed 8 August 2024.
3 Medical cost finder – Breast reduction, 2022-23. Accessed 8 August 2024.
4 Medical cost finder – Bilateral mastectomy for gynecomastia, 2022-23. Accessed 8 August 2024.
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