Does health insurance cover breast implants?
It depends
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.
- 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 when It's elective cosmetic augmentation with no medical indication.
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.
Key facts
- Verdict
- It depends
- Applies to
- breast implants · Health insurance
- Covered when
- The implants are part of breast reconstruction after a covered mastectomy — WHCRA requires plans that cover the mastectomy to cover reconstruction.
- Not covered when
- It's elective cosmetic augmentation with no medical indication.
- Verified
- 2026-07-03 · 2 primary sources
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.
What people typically pay
For reconstruction after a covered mastectomy, you typically pay your normal cost sharing — such as your deductible and coinsurance up to your out-of-pocket maximum. Amounts vary widely by plan, so check your Summary of Benefits.
Purely cosmetic breast augmentation is generally paid entirely out of pocket. Prices vary widely by region, surgeon, implant type, facility, and anesthesia.
The gap between covered and uncovered is driven almost entirely by whether the surgery is reconstruction after a mastectomy or a medically necessary correction versus elective augmentation.
How to actually get it covered
Confirm your plan covers mastectomy — WHCRA's reconstruction requirement only applies to plans that do; check your Summary of Benefits or call member services.
Have your surgeon and oncologist document the medical basis: for reconstruction, the mastectomy record; for a congenital case, the diagnosed deformity and why implants are medically necessary.
Ask your surgeon's office to submit a prior-authorization request for the reconstruction or reconstructive procedure, including the surgical plan.
Confirm in writing that the plan will cover reconstruction, symmetry surgery on the other breast, prostheses, and treatment of complications, as WHCRA requires.
Verify the surgeon and facility are in-network to keep your cost sharing predictable, and get an estimate of your deductible and coinsurance.
If any part is denied, request the denial reason in writing and file an internal appeal citing WHCRA for reconstruction claims or the plan's medical-necessity criteria for congenital cases.
Common questions
Does my insurer pay for the mastectomy on both sides if only one breast had cancer?
WHCRA requires plans that cover the mastectomy to also cover surgery on the healthy breast to produce a symmetrical appearance. That can include reshaping or placing an implant in the unaffected breast if that's what achieves symmetry, when the patient and their surgeon determine it's part of the reconstruction.
Will insurance cover removing or replacing implants that were placed during reconstruction?
WHCRA covers treatment of physical complications of the mastectomy, including complications from the implants used in reconstruction. How that applies to specific revision or replacement situations depends on your plan's terms, so confirm with member services. Coverage for elective swaps unrelated to a medical complication is a different story and usually isn't included.
How do I get implants for a congenital deformity approved when augmentation isn't covered?
You'll typically need your surgeon to document the deformity and frame the surgery as medically necessary rather than cosmetic, then submit a prior-authorization request before scheduling. Approval hinges on the plan's specific medical-necessity criteria, so the clinical documentation matters more than the label. This is subject to your plan's rules — confirm with your insurer.
If I want purely cosmetic augmentation, is there any way insurance helps?
Generally no — elective augmentation to change size or shape without a medical indication is excluded, so you pay the full amount yourself. Insurance only enters the picture if the surgery later causes a covered medical complication, and even then coverage of the complication doesn't reimburse the original elective procedure.
Does WHCRA apply to my plan, or are there exceptions?
WHCRA applies to group health plans that cover mastectomies, and the plan must actually cover the mastectomy in the first place for the reconstruction requirement to apply. Some plans may operate under different rules, so confirm your specific plan documents to be sure. If your plan covers mastectomy, it must also cover the reconstruction.
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