How much you can get

How much you get depends on the claim you make.

Reimbursement rates

You can get up to:

  • $400 for a prosthesis following a single mastectomy
  • $800 for double prostheses following a double mastectomy.

The total amount we reimburse will depend on the claim you make with us. We use the details in your claim to work out how much you get. This includes if you have private health insurance.

If you get financial assistance from the Department of Veterans’ Affairs (DVA), you should claim your entitlement through DVA.

Once you’ve claimed from your private health insurer, we may pay the difference if the reimbursement amount:

  • is less than the full price you paid for it
  • isn’t more than the $400 limit you can get for each prosthesis.

Example of claiming when you don’t have private health insurance

Alex had a double mastectomy and requires 2 prostheses. She was able to buy the 2 prostheses for $130 each. Alex doesn’t have private health insurance. This means she can claim the full amount of $260 from us for her prostheses. This is because each prosthesis was under $400.

Example of claiming when you have private health insurance

Taylor had a mastectomy. She bought her prosthesis for $400 and gets $200 back from her private health insurer. Taylor then makes a claim with us and gets another $200 back. This is the difference between the $400 limit we can give Taylor and her private health refund amount.

Cover for the upfront cost of a prosthesis

If you get certain Centrelink income support payments, you may be eligible for an advance payment. You can use this to help cover the upfront cost before you claim.

You need to do the following:

  • check if you meet the advance payment rules
  • apply for the advance
  • agree to the repayment schedule.

If you’re successful, you can use the advance payment to buy your prosthesis. Then claim reimbursement from us. You can use this money to pay back your advance or keep repaying it based on your agreed schedule.

Page last updated: 15 January 2024.
QC 51137