External Breast Prostheses Reimbursement Program

Help with the cost of breast prosthesis after breast cancer surgery, up to a maximum of $400 for each prosthesis.

Eligibility basics

  • you’re enrolled in Medicare
  • you’ve had breast surgery as a result of breast cancer
  • you haven’t claimed under this program in the past 2 years

Eligibility & payment rates

Eligibility

You’re eligible for this program if:

  • you’ve had breast surgery, prophylactic or preventative mastectomy as a result of:
    • breast cancer, or
    • diagnosis of pre-cancerous cells, non-invasive breast cancer or intraductal cancer
  • you’re eligible for a Medicare card, and
  • you’ve not made a claim under this program in the past 2 years

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 will be $130 as it's under the maximum reimbursement of $400
  • if you had a bilateral mastectomy and purchased 2 prostheses for a total of $800, your reimbursement will be $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 will be $800, as the maximum reimbursement for each prostheses is $400

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.

The reimbursement is paid into the bank account you nominate on the claim form. We'll send you a payment statement for your records.

Time limits

You can claim for prostheses purchased after 1 July 2008. No timeframes apply on when the breast surgery was performed.

You can claim for new or replacement prostheses. There must be a 2 year period between the purchase dates of your prostheses if you’re claiming for a replacement.

For example, if you claim for a prosthesis purchased on 1 April 2015, you’ll only be able to claim for a replacement purchased after 1 April 2017.

For more information call the Medicare general enquiries line or visit a service centre.

Claiming

Once you’ve read about eligibility, the next steps are:

  1. find out what you need before you start your claim
  2. choose your claiming option
  3. provide supporting documents
  4. submit your claim
  5. we’ll assess your claim and let you know the outcome

Next

Managing your payment

Exclusions

The program doesn’t cover other items such as bras, post breast surgery swimwear or internal prostheses.

Resources

Payment and Service Finder

Find, estimate and compare payments and services you may be eligible for. You can also work out what a change in circumstance might mean for the payments and services you currently receive from us.

Start using Payment and Service Finder

Manage your money

 

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Read about how to manage your money.

Page last updated: 27 August 2017