External Breast Prostheses Reimbursement Program

A reimbursement for new or replacement external breast prostheses for women who have had a mastectomy due to breast cancer.

Eligibility basics

  • be eligible for Medicare
  • had a mastectomy due to breast cancer

Eligibility & payment rates

Eligibility for the External Breast Prostheses Reimbursement Program

You are eligible for this program if you:

  • have had a mastectomy as a result of breast cancer
  • are eligible for Medicare, and
  • have not made a claim under this program in the past 2 years

Should you require a new prosthesis within the 2 year period due to cancer treatment or other medical condition, you may be eligible for a further reimbursement.

Medicare card holders on a Reciprocal Health Care Agreement are not eligible.

Residence requirements

If you are a Medicare card holder, there are no further residence requirements. Read more about eligibility for Medicare Card. However, if you are eligible for Medicare under a Reciprocal Health Care Agreement you will not be eligible for the External Breast Prostheses Reimbursement Program.

Reimbursement amount

You can claim a reimbursement of up to $400 for an external breast prosthesis for each breast.

For example:

  • if you purchased a single prosthesis for $130, your reimbursement is $130 as it is under the maximum reimbursement of $400
  • if you had a bilateral mastectomy and purchased 2 prostheses for a total of $800, your reimbursement is $800 as you get $400 for each prosthesis
  • if you had a bilateral mastectomy and purchased 2 prostheses for a total of $1,000, your reimbursement is $800, as the maximum reimbursement for each prostheses is $400

The reimbursement is paid into the bank account you nominated on the claim form. A payment statement will be sent to you for your records.

If you received other refunds or financial assistance

Your reimbursement will be reduced if you received a refund for your prosthesis from other sources, such as your private health fund.

You can still claim the reimbursement if the amount you received from other sources was less than the full purchase price of the prosthesis, and less than the total reimbursement limit of $400 for each prosthesis.

For example, if you buy a prosthesis for $500 and get a $200 refund from your private health fund, your reimbursement from us will be $200.

Time limits

You can claim a reimbursement for new or replacement external breast prosthesis purchased after 1 July 2008. No timeframes apply on when the mastectomy was performed.

There must be a 2 year period between the purchase dates of your external breast prosthesis before another claim can be made.

If you require a new prosthesis within the 2 year period, due to cancer treatment or another medical condition, you may be eligible for a further reimbursement.

For further information please visit a service centre or call our Medicare general enquiries lines on 132 011.

Other benefits

If you are eligible for the External Breast Prostheses Reimbursement Program, you may be entitled to other payments and benefits, such as:

Claiming

Once you have read about eligibility, the next steps are:

  1. complete the claim form
  2. provide supporting documentation
  3. submit your claim

We will assess your claim and let you know the outcome.

Next

Managing your payment

Exclusions

The program does not cover other items such as bras, mastectomy swimwear or internal prostheses.

Resources

Other information sources

Payment Finder

Select the options that describe your circumstances then explore a suggested list of possible Centrelink and Medicare payments and services online.

Start using Payment Finder

Service Finder

Select your state and topics of interest to find links to government and community organisation support.

Start using Service Finder

This information was printed from humanservices.gov.au It may not include all of the relevant information on this topic. Please consider any relevant site notices at humanservices.gov.au/siteinformation when using this material.