Under state and federal law, if your insurer covers mastectomies, it must also cover related services. These include reconstructive surgery or breast prostheses (also called forms) if you don't want surgery. This is true even if you didn't have a cancer diagnosis and even if your surgery is delayed. Coverage includes:
- Reconstruction of your breast that had the mastectomy.
- Surgery and reconstruction of your other breast to help both look similar.
- Prostheses that fit into your bra before or during the reconstruction.
- Treatment of physical issues from the mastectomy, including swelling due to fluids in your arm or chest.
- Hospitalization, if necessary.
Your insurer must tell you about this coverage when you join a plan and remind you every year.
Exceptions to coverage
Individual and employer health plans that cover mastectomies also cover breast reconstruction services. Employers who fund their own health plans must ask the federal government for permission to deny this coverage. Medicare and Washington Apple Health (Medicaid) also cover breast reconstruction surgery and services after a mastectomy. Contact the person who manages your employer's health plan if you have questions about your coverage.