Costs and financial assistance for breast prostheses

The cost of a breast prosthesis and bra varies depending on the type, which may influence your choice. Some women may choose not to replace the prosthesis regularly because of the cost.

Learn more about:

• The average cost of each prosthesis and bra
• Reimbursement from Medicare
• Private health insurance

Guide to the average cost of each prosthesis and bra

Reimbursement from Medicare

The cost of a new or replacement breast prosthesis can be claimed through Medicare. Women who are permanent residents of Australia, are eligible for Medicare, and have had a full or partial mastectomy as a result of breast cancer can claim for a new prosthesis every two years.

At the time of publication, Medicare’s External Breast Prostheses Reimbursement Program provides up to $400 for each new or replacement breast prosthesis. If you’ve had a bilateral mastectomy, you are eligible for reimbursement for two breast prostheses of up to $400 each.

As policies change, check what assistance is available before you buy prostheses or bras.

How to make a claim for a replacement prosthesis:

• Allow two years or more between the purchase dates of the prostheses. In some cases, you may be able to make additional claims but you will need to provide a letter from your doctor or surgeon.
• Claim any refund from your private health insurance first if you’re eligible.
• Obtain a claim form from any Medicare office, download it from Services Australia or call Medicare on 132 011 to request it in the mail.
• Scan the original receipt, attach it to the claim form and return this by email, post or in person at a Medicare Service Centre. You cannot make a claim online. The payment will be made by electronic funds transfer into your bank account.

Private health insurance

Rebates for breast prostheses and related products such as mastectomy bras vary between private health funds. Some rebates only apply to members with extras cover.

Most health funds have waiting periods and other terms and conditions. They may also require a letter from your surgeon stating why you need a prosthesis. Ask your health fund what is covered and what information they need from you.

If you have private health insurance, you may also be able to claim a reimbursement from Medicare. If the full price of the prosthesis wasn’t covered by your private health insurer, you can claim through Medicare, but this reimbursement will be adjusted according to the $400 limit.

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