The Australian Government Department of Human Services can help you with the cost of your prostheses after breast cancer surgery, through their External Breast Prostheses Reimbursement Program . You can get up to a maximum of $400 for each new or replacement prosthesis.
The rebate is for any type/style of external breast prostheses Eg: silicone, lightweight or fabric.
- you need to be enrolled in Medicare (card holders on a Reciprocal Health Care Agreement are not eligible)
- you have to have had breast surgery as a result of breast cancer
- you have not purchased and claimed under the program in the past 2 years
- Pay for the cost of the prostheses upfront*
- If you have private health insurance, firstly claim any applicable refunds from them. If your fund doesn’t cover the cost you can then claim from Medicare (up to the $400 limit for each prosthesis)
- If you don’t have private health, simply claim with Medicare (unless you get a payment from the Department of Veterans’ Affairs, in which case you should claim from them- see information at the bottom of the page).
*If you can’t afford the upfront cost of a prosthesis and you get certain income support payments you may be eligible for an advance payment (to pay for them). You would need to check with Medicare if you meet the advance payment rules, apply for the advance, and agree to the repayment schedule.
- If you buy a prosthesis for $500 and get a $200 refund from your private health fund, Medicare will pay you $200. This is the difference between the $400 limit and your refund amount.
- If you don’t have private health and buy 1 prosthesis that costs you $150, Medicare will reimburse you the full $150. This is because it’s under the maximum reimbursement amount of $400.
- If you don’t have private health and had a bilateral mastectomy and you buy 2 prostheses, you can get up to $400 for each prosthesis. If they cost you $800 Medicare will pay you back the full $800. If they cost you $1,000, Medicare will pay you back $800 as this is the maximum refund.
As you can only claim on breast prostheses once every two years we recommend that you claim your rebate for the most expensive purchase Eg: If you buy a silicone prostheses and a fabric prosthesis you would be best to claim the refund for the silicone one as you will receive more money back (as the silicone prosthesis costs more than the fabric one).
When to claim:
- You can claim for new prosthesis if it’s at least 2 years since you bought your last prosthesis. This applies regardless of your last reimbursement amount. Medicare base this on the dates on your purchase receipts
If it’s been less than 2 years since you bought a prosthesis, you can only claim for a replacement if it’s for a medical reason. The claim must include a letter from your doctor or other health professional explaining the medical reason why you need a new prosthesis. You can’t claim a reimbursement for a replacement prosthesis, bought less than 2 years after your last purchase, for wrong choice or change of mind, incorrect fitting or faulty or damaged prostheses.
- You can claim for prostheses you bought after 1 July 2008 even if you had your breast surgery before then. 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 you bought on 1 April 2018, you can’t claim for the cost of a replacement unless it’s bought after 1 April 2020.
How to Claim and how Glamozon will help:
For your rebate you will need a claim form (found here: Medicare Claim Form), your purchase receipt ( which must include a description of what you bought, the date and supplier information), as well as any other documents Medicare asks you for.
The quickest, easiest way to submit the claim is by scanning and emailing it to the address on the form. Alternatively you can post it or take it to a service centre. All details are on the form.
Glamozon will send you a Medicare claim form with your receipt. We will also send you an additional copy of your receipt in case you have private health insurance and would like to make a claim with them.
Medicare will process most claims within 10 business days after they get the claim. They will send you a payment statement if your claim is successful and will pay your reimbursement into the bank account you nominate on the claim form. If they reject your claim, they will send you a letter explaining why.
To find out more on the program, go to the Human Services Medicare website : External Breast Prostheses Reimbursement Program or call their general enquiries line on 132 011
If you want a claim form you can print one off by clicking this link: Medicare Claim Form
The Department of Veterans’ Affairs Rebates:
- If you are happy to pay upfront, you can lodge a claim for out-of-pocket medical expenses by completing an “Application for Reimbursement of Medical Expenses Privately incurred” form (also known as a d1181 form) which is found on the DVA website: ( https://www.dva.gov.au/about-us/dva-forms/claim-out-pocket-medical-expenses ). The form is at the bottom of that page and you can download it and print it off. You then complete it and return it to DVA with your receipt that shows you have paid.
- If you are unsure whether you are able to claim for reimbursement, or if you can’t afford to pay upfront, please contact us first. In this instance we will contact the Department of Veterans’ Affairs directly for you to request prior approval. If the request is approved we will invoice the DVA directly for the purchase and you will not be charged.