Does Medicaid Cover Gynecomastia Surgery? [Everything You Need To Know]


Does Medicaid cover gynecomastia surgery? The short answer is no, at least not in its traditional sense of covering all forms of medical care, so your options are pretty limited if you want to undergo the procedure but don’t have the money to pay for it on your own.

You can always opt to fund the surgery yourself and pay out of pocket, but you may also be able to get Medicaid to pick up the tab, depending on your state and how much coverage you qualify for.

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Here’s what you need to know about Medicaid and getting coverage for male breast reduction surgery.

What is Gynecomastia?

Gynecomastia is a condition that causes enlarged breasts in men. It can affect one or both breasts, and can occur at any age.

While the exact cause is unknown, it is thought to be hormonal. There are two types of gynecomastia: true gynecomastia, which is caused by an excess of glandular tissue, and pseudo-gynecomastia, which is caused by an excess of fat tissue.

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Treatment usually involves surgery to remove the excess tissue.

Is this common in young men?

Though it’s not talked about as much as other medical procedures, gynecomastia surgery is actually quite common. In fact, according to the American Society of Plastic Surgeons, over 30,000 men had the procedure done in 2016.

And that number is only increasing; ASPS reports that the number of men getting gynecomastia surgery has gone up by 48% since 2000.

What causes Gynecomastia?

There are a number of things that can cause gynecomastia, including certain medical conditions, medications, and substances.

In some cases, the exact cause is unknown. But we do know that it happens when there is an imbalance of the hormones estrogen and testosterone in the body. This can happen because of:

  1. A medical condition that affects hormone levels, such as kidney failure or hyperthyroidism
  2. Taking certain medications, such as antipsychotics, antidepressants, and heartburn medications
  3. Using street drugs, such as marijuana, heroin, and methamphetamines
  4. Drinking too much alcohol

Does Medicaid cover gynecomastia surgery?

Medicaid is a state and federal health insurance program for low-income Americans. While Medicaid does not explicitly cover gynecomastia surgery, there are some ways to get coverage.

First, check with your Medicaid office to see if your state covers the surgery.

If not, you may be able to get coverage through a Medicaid waiver program. Finally, you can try to negotiate with your surgeon or hospital to get them to accept Medicaid payments.

4 Options for Treating Gynecomastia (if you have insurance)

  1. If you have insurance, check with your provider to see if gynecomastia surgery is covered.
  2. Many providers will not cover the surgery if it is considered cosmetic, but some will if it is causing pain or emotional distress.
  3. You may be able to get coverage by getting a letter from your doctor stating that the surgery is medically necessary.
  4. If your insurance does not cover the surgery, you can try to negotiate with your provider or look into other financing options.
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The cost of treating gynecomastia without insurance can be more than $7,000.

There are a few things you should consider before deciding to get a breast reduction. First, understand that the surgery is not covered by insurance, including Medicaid.

You will be responsible for the entire cost, which can range from $3,000 to $10,000. Second, the surgery is considered cosmetic and is not medically necessary. This means that it is not covered by Medicaid or any other type of health insurance.

Third, the surgery requires a hospital stay and general anesthesia, which carries risks. Fourth, the recovery period is typically four to six weeks and you will likely experience some pain and discomfort during this time.

Fifth, there is a chance that your breasts will not be symmetrical after the surgery. Sixth, you may have scars from the incisions made during the procedure.

What are the pros and cons of getting a breast reduction?

There are a few things you should consider before deciding to get a breast reduction. First, let’s look at the pros:

  1. You will likely experience less back and neck pain.
    2.Your clothing will fit better and you may feel more comfortable in your own skin.
  2. Exercise will be easier and you may see an improvement in your physical appearance.

Now let’s look at the cons:

  1. The surgery is usually not covered by insurance, so you will have to pay out of pocket.
  2. There is a risk of infection, bleeding, and scarring.
  3. You may be left with uneven breasts or asymmetry.

The Benefits of Getting a Breast Reduction via Insurance vs. Without Insurance

If you’re considering a breast reduction, you may be wondering about the cost. Breast reduction surgery is not cheap, and if you don’t have insurance, you may be wondering how you will be able to afford it.

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Luckily, there are options available to help make the surgery more affordable.

One option is to get insurance to cover the surgery. Another option is to pay for the surgery without insurance. Each option has its own set of benefits and drawbacks that you should consider before making a decision.

If you decide to get insurance to cover your breast reduction surgery, there are a few things you need to do. First, you need to find a doctor who is willing to work with your insurance company.

Plan of Action – How To Get Medicaid To Cover Your Breast Reduction Surgery

  1. Check if you qualify for Medicaid. You can do this by going to your state’s Medicaid website or contacting your local Medicaid office.
  2. Find a surgeon who accepts Medicaid. You can ask your primary care doctor for a referral or look for a surgeon on your state’s Medicaid website.
  3. Schedule a consultation with the surgeon. During the consultation, be sure to ask about the surgeon’s experience with performing gynecomastia surgery and whether they accept Medicaid.
  4. Get pre-authorization from Medicaid. This may require you to get approval from your primary care doctor as well as from a plastic surgery review board.
  5. Have the surgery performed by the qualified surgeon.

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