External Breast Prostheses Reimbursement Program
- 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
- 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 for the External Breast Prostheses Reimbursement Program
Reimbursement amount for the External Breast Prostheses Reimbursement Program
You can claim a reimbursement of up to $400 for each new or replacement external breast prosthesis. This limit applies for each prosthesis, for each breast.
- 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 still $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.
Reimbursement amount 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 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 under the External Breast Prostheses Reimbursement Program
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 Medicare Service Centre or call Medicare general enquiries on 132 011.
Other benefits while receiving the External Breast Prostheses Reimbursement
If you are eligible for the External Breast Prostheses Reimbursement Program, you may be entitled to other payments and benefits, such as:
Once you have read about eligibility the next steps are:
- complete the claim form
- provide supporting documentation
- submit your claim
We will assess your claim and let you know the outcome.
Managing your payment
Exclusions under the External Breast Prostheses Reimbursement Program
The program does not cover other items such as bras, mastectomy swimwear or internal prostheses.
Other information sources
Select the options that describe your circumstances then explore a suggested list of possible Centrelink and Medicare payments and services online.
Select your state and topics of interest to find links to government and community organisation support.