How Obamacare can help women with breast implant problems!

For years we have heard from women with leaking breast implants and other serious implant problems who want to get their implants removed but can’t afford it.  Breast cancer patients who have health insurance have been covered but augmentation patients have not.  And, breast cancer patients who couldn’t afford health insurance (and there are many) were also out of luck.  Many women who have been in this situation or might be in the future will find that Obamacare is a great help! We encourage women to take advantage of the law while it is still in place, because it might be repealed or substantially changed in the future.

  • Under Obamacare, health insurance companies can’t refuse to pay for health problems related to a pre-existing condition.  Before Obamacare (the Affordable Care Act), many insurance companies considered breast implants a pre-existing condition.  Under Obamacare, insurance companies are generally required to pay for services that are medically necessary, even if the reason for the health problem is a pre-existing condition.  However, some insurance companies may try to exclude any services related to complications from cosmetic surgery, so read the policies carefully before you choose.
    • California, Florida, Massachusetts, New York, North Carolina, Texas, and Washington tend to be especially good about coverage for medically necessary services, even those related to previous cosmetic surgery. Medically necessary services usually include removal of leaking silicone gel breast implants, as well as removal of implants causing severe capsular contracture, serious infections, chronic pain, ALCL (a rare cancer of the immune system), or other serious health problems that a doctor says are caused by implants.
  • The State Insurance Exchanges offer health insurance policies that will be better and more affordable than most policies available to individuals who aren’t insured through their workplace.  It is important to go to www.healthcare.gov and look into the plans offered on your state’s Exchange. If you have lost an existing health insurance policy because of a change in marital status or job or other reasons, you can sign up for the exchange now – otherwise, the only time to sign up is between November 1 and December 15, you can get coverage starting January 1, 2018.  You will find pricing information for 2018 on the website. The lower your income, the less you will have to pay for these health insurance policies.  Check out the choices you have in your state on www.healthcare.gov and sign up as soon as you decide and definitely before Dec. 15, 2017 if you want to start your health insurance on January 1.  And make your appointment now for January surgery, if you need it!
  • To make sure that the policy you plan to buy includes implant removal or other coverage for the kind of implant problems you have, ask that question BEFORE you buy the policy.  If they can’t answer your question or tell you it would not be covered, please contact us immediately at info@center4research.org.  We will do our best to help.
  • In many states, Medicaid is available for free to any individual or family under 133% of the poverty line (that’s about $30,000/year for a family of 4).  Medicaid must provide coverage for pre-existing conditions and so it should include surgery or services that a doctor considers medically necessary, such as removing leaking silicone gel breast implants, implants causing chronic pain or infections, and other serious health problems.   If you are on Medicaid or Medicare and have problems getting this coverage, please contact us immediately at info@center4research.org .