Unexpected Challenges 11 Years After Breast Cancer

Bonnie Annis is a breast cancer survivor, diagnosed in 2014 with stage 2b invasive ductal carcinoma with metastasis to the lymph nodes. Catch up on all of Bonnie's blogs here!

When my husband retired and we lost his health insurance, I wasn’t worried. I knew we’d qualify for Medicare. I assumed, like many others, that in my old age, the government-provided health care would take care of most of my needs. I wasn’t naïve in thinking I’d get the same quality coverage I’d received through my husband’s insurance company, but assumed it’d be close. Boy, was I mistaken.

When it came time to buy new breast prostheses and mastectomy bras, I went to our local shop. I’d become friends with the owner after my first visit and the subsequent visits. Every two years, under my husband’s policy, I was entitled to new breast prostheses. Since I’d had a double mastectomy, I was thankful. Silicone prostheses don’t last forever, even if you take good care of them. Mine had gotten old and wrinkly from constant wear and were ready to be replaced by the end of each two-year period. And the bras, with constant use, wore out quickly. I was thankful I qualified for four new mastectomy bras every year under his plan. Since this was the first time visiting the shop without company insurance coverage, I wasn’t sure about my Medicare coverage or benefits.

I talked with the shop owner, and she asked for my Medicare card. She was going to call and verify coverage. While she was calling, she told me to look around the shop and see if I saw anything I liked. I explained I didn’t really need to do that since I’d been coming so long. I’d found, through years of trial and error, my favorite breast prostheses and bras. Smiling, I said, “I’ll just reorder the ones I’ve purchased in the past. That way it will be easier for both of us.” She pulled my folder from a file cabinet and verified the products I wanted, then went in the back to call Medicare. When she came out, I could tell by the look on her face the news wasn’t good.

Leaning over the counter, she told me in a soft voice that the coverage wasn’t great. Medicare was only going to pay fifty percent of the costs, and the remainder, over $500, would be out of pocket. Taken aback, I inhaled and said, “I can’t really afford that. We’re living on a fixed income – solely on Social Security.” She was kind and understanding. Closing my folder, she said, “Let me know if things change.”

When I got out to the car, I talked to my husband. Explaining the information I’d received, he was as disappointed in our coverage as I was. We didn’t understand why Medicare didn’t cover the products at 80% like our old insurance coverage. Wasn’t government care supposed to be better?

When I got home, I looked up some information on the internet and found some unexpected information. I knew, from past research, that the Women’s Health and Cancer Rights Act of 1998 provided protection for patients who’d chosen to have breast reconstruction surgery. It was also supposed to allow for treatments related to complications from mastectomy, like lymphedema, an unexpected side effect I suffered after having lymph nodes removed. The act supposedly had provisions for prostheses and bras, but according to information listed on the American Cancer Society’s website, the law didn’t include Medicare or Medicaid coverage.

Finding that information was frustrating. It felt like I was being punished for two things: for being an older adult under government health care coverage and for being a breast cancer survivor.

I guess 50% coverage is better than nothing, but when each silicone breast prosthesis costs between $400 and $600 and I needed two of them, that was a lot to come up with out of pocket. On top of that, each mastectomy bra was between $50 and $75 dollars! When you’re living on a fixed income, how can you justify spending that much money to look normal? I could buy several months’ worth of groceries for the same price.

Considering all that, I decided I’d make my old, wrinkly boobs last a little longer. At least they’d be hidden in my dingy, gray mastectomy bra from last year. And when they were no longer usable, I’d opt for another choice. I found several cheaper options online. Of course, those are not high-quality silicone prostheses with cooling gel backs, like my old ones, but they’d work in a pinch. They were made of molded foam and were able to be inserted into a mastectomy-type camisole that’d work just about as well as an expensive mastectomy bra. For one-fourth of the price of the silicone boobs and nice, pocketed mastectomy bras, I could look normal. And, if I felt I couldn’t fork out $100 a pop for a set of those, I could always resort to stuffing an old bra with polyester fiberfill.

Sometimes, I wish I’d gone the reconstruction route. At least that would have been a “once and done” kind of thing. But after seeing some of the results from that type of surgery and the abnormal appearance of the built-in breasts, I figured I’d be better off faking my femininity.

If you’re an older woman, like me, and need breast prostheses or mastectomy bras, you might want to check your Medicare coverage before heading to a shop for your purchases. Since I have a Medicare Advantage plan, my coverage may be a little different than those with standard Medicare parts A and B. I’m not sure. If you’re blessed to have company insurance, you may want to check that coverage, too. And if you haven’t read through the WHCRA, you may want to do it. Medical professionals don’t always know the ins and outs of the law. Remember, you must be your own advocate when it comes to health-related issues and especially those relating to breast cancer.

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