This one is short, and sweet.

I have written an explanatory article on my website about the difference between "medically necessary" and "cosmetic" procedures, and how this is what determines the applicability of Medicare / private insurance rebates. Have a read of that if you are looking for clarification.

But to answer the question I have posed above, then the short answer is yes. Medicare does provide a rebate for breast implant removal/explant surgery.

If you have your implants removed with at least half of the implant capsule, then item number 45551 applies. If an item number applies, then you will be entitled to Medicare (and private insurance) rebates on your surgery

That doesn't mean that your surgery is "totally covered" by Medicare and private insurance. It doesn't entitle you to "free" surgery. That is not how the world works.

But it does provide some benefit.

The way that Medicare and the private insurance systems interact in Australia is confusing for most patients.

The summary version is this:

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• if you have private insurance, a Medicare rebate on your surgery will entitle you to a private insurance benefit as well. You will also be entitled you to Medicare/private insurance rebates on your anaesthetic. Most importantly, your private insurance (not Medicare) will cover part (or all) of your hospital fees. The degree of coverage of your hospital fees will depend on whether you are only having a procedure for which there is a rebate, or if you are having a combined procedure which is partly covered by a rebate and partly cosmetic in nature. In the latter case, you will be responsible for all the costs of the cosmetic component.

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• if you don't have private insurance (what hospitals will refer to as "self-funded"), then you are still entitled to Medicare rebates on your relevant surgical fees and anaesthetic fees, but you will be completely responsible for any hospital fees and for any costs associated with cosmetic portions of your surgery.

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Unfortunately, Medicare and private insurance rebates don't add up to all that much when it comes to your surgery and anaesthetic fees. There is some benefit but most of the cost savings that comes from having private insurance is due to the reduction in your hospital fees.

And just to clarify (because I have written about this before): if you want to have cosmetic breast implants replaced, you will NOT be entitled to any rebate. I don't care how other surgeons might try to twist the item number description, the intention of item numbers for implant replacement (45553 and 45554, if you're interested) is for patients who had their implants placed due to previous cancer surgery or surgery to correct developmental differences. If you have had a purely cosmetic breast augmentation and have been told you can have your implants replaced and covered by insurance, then I hate to break it to you, but the surgeon who told you that is engaging in Medicare fraud. Bugger, hey?

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Ok, hope that makes sense. Bye.