How much you can get
How much you get depends on the claim you make.
You can get up to $400 for each prosthesis back from us. This is for the cost of a new or replacement prostheses.
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.
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
Mary had a bilateral mastectomy. She requires 2 prostheses. She was able to buy the 2 prostheses for $130 each. Mary doesn’t have private health insurance. This means she is able to claim the full amount of $260 from us for her prostheses. This is because each prostheses was under $400.
Example of claiming when you have private health insurance
Trish had a mastectomy. She bought her prosthesis for $400 and gets $200 back from her private health insurer. Then Trish makes a claim with us and gets another $200 back. This is the difference between the $400 limit we can give Trish 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: 23 July 2019
This information was printed 2 July 2020 from https://www.servicesaustralia.gov.au/individuals/services/medicare/external-breast-prostheses-reimbursement-program/how-much-you-can-get. It may not include all of the relevant information on this topic. Please consider any relevant site notices at https://www.servicesaustralia.gov.au/individuals/site-notices when using this material.