Does health insurance cover breast implants?
Cosmetic breast augmentation is almost never covered, but federal law requires plans that cover a mastectomy to also cover reconstruction — including implants — after that surgery.
What flips the answer
- Covered when
The implants are part of breast reconstruction after a covered mastectomy — WHCRA requires plans that cover the mastectomy to cover reconstruction.
- Covered when
Your plan approves implants as medically necessary to correct a congenital deformity, with prior authorization.
- Not covered when
It's elective cosmetic augmentation with no medical indication.
Purely cosmetic breast augmentation — implants to change size or shape without a medical need — is treated as elective and is generally excluded from health insurance.
The major exception is reconstruction after cancer surgery. Under the federal Women's Health and Cancer Rights Act (WHCRA), a group health plan that covers mastectomy must also cover breast reconstruction, surgery on the other breast to produce a symmetrical appearance, breast prostheses, and treatment of physical complications — including implants used in reconstruction.
Some plans may also cover implants for other medically necessary reasons, such as correcting a significant congenital deformity, subject to the plan's medical-necessity rules and prior authorization. Elective augmentation remains out of pocket.
That's the general answer. Yours is written in your actual policy.
Drop in your policy or benefits document and get the answer for your exact coverage — with the clause it comes from. Nothing is stored.
Check my policy →