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Medicare Breast Prostheses Reimbursement Scheme - A Guide
What is the Scheme?
In 2009 The Commonwealth Government announced the national 'Medicare Breast Prostheses Reimbursement Scheme'. This scheme is simple and convenient to use, no matter where you live in Australia.
What can I claim?
The scheme allows women to claim the cost of a prosthesis every two years (up to the value of $400 per prosthesis), with all claims made through Medicare. This is available for 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. If a woman has had a bilateral mastectomy, she is eligible to claim for both prostheses. It does not matter how long ago the mastectomy was performed. E.g. If a prosthesis for $300 is purchased, you will receive a reimbursement of $300. If the prosthesis cost $420 you will receive a reimbursement of $400. Medicare will not reimburse the cost of bras or swimwear etc.
How can I claim and how long will it take?
Please note that if you are already receiving assistance from the Dept. of Veteran Affairs you should claim through them. They will also cover the cost of two bras every 6 months.
A prosthesis will normally last for 2- 3 years so this scheme allows women to have access to a quality prosthesis as well as keeping up to date with advances in their development.
The claim forms are available at the Medicare office or can be downloaded at External breast prostheses reimbursement claim form. They can be lodged with any Medicare office or posted directly to Dept of Human Resources GPO Box 9822 in your capital city. I always have the forms available and am happy to complete the form and even post it if requested. The reimbursement is deposited into your nominated bank account within 2-3 weeks. (I had one customer who had the reimbursement in their account within 3 days!)
What if you have private health insurance?
Check with your health fund as to what you are entitled to. If you have extras or high cover you may be reimbursed for the cost, or part thereof, of mastectomy bras and swimsuits as well as a prosthesis. If the fund does cover the cost of a prosthesis, some women will claim their everyday prosthesis through the Medicare Reimbursement Scheme and then claim a swimming prosthesis or leisure form through their private health fund.
Breast Cancer Network Australia was instrumental in the introduction of this scheme as they vigorously lobbied the government for its establishment. They are also currently raising the issue of women not being in a position to pay the upfront cost of a prosthesis. They state:
While the Program has benefited many women since its introduction, BCNA is concerned that some women, particularly those on low and fixed incomes such as pensions, may not be able to afford the upfront cost of a prosthesis (up to $400) and so may not be able to access the Program. BCNA has raised these concerns directly with the Health Minister, and the Department of Health and Ageing (DoHA).
You can See more at: https://www.bcna.org.au/about-us/advocacy/campaigns#BreastProsthesis
There is no doubt that this Scheme has greatly benefited women who have had breast surgery. Unfortunately, there are still women who are unaware of its existence, especially those who had surgery a number of years ago. It is my hope that all women will know about and have access to this Scheme as soon as possible. Being comfortable and confident in appearance is a positive step on the path to recovery after breast cancer surgery.
Useful Links
For more information about the Medicare Reimbursement Scheme visit: