External Breast Prostheses Reimbursement Program

What Is This Payment?

The External Breast Prostheses Reimbursement Program helps with the cost of external breast prostheses for women who have had a mastectomy because of breast cancer. An external prosthesis is worn in a bra rather than surgically implanted, and needs replacing periodically as it wears.

The rule database tags it as a Group B benefit with eligibility_only as its result role, inside the Federal Health cluster. The headline figure is up to $400 per prosthesis, claimed as a reimbursement after you buy the prosthesis.

It is available for both an initial prosthesis and replacements, with the reimbursement renewing on a set cycle. There is no income or assets test — eligibility is based on having had a mastectomy because of breast cancer.

How Much Can You Get?

The amount block is eligibility_only with period: none, but the headline figure is concrete: reimbursement of up to $400 for each prosthesis.

• Up to $400 per prosthesis — you claim back what you paid, up to the cap.
• One per side where you have had a mastectomy on both sides — so a bilateral mastectomy can mean two reimbursements.
• Renews for replacements on a defined cycle, since prostheses wear out and need replacing over time.

Eligibility Conditions

The eligibility block is an all set.

1. Mastectomy for breast cancer: had_mastectomy_for_cancer = true. The program is for women who have had a mastectomy because of breast cancer and need an external breast prosthesis.

Beyond having had the mastectomy, you need a Medicare card and a receipt for the prosthesis, since the benefit is a reimbursement of what you paid. There is no income or assets test.

Required field is had_mastectomy_for_cancer. The product surfaces the program to eligible women because reimbursement is often missed — both the initial claim and, importantly, the replacement reimbursements that renew on a cycle.

How To Apply

The channel is online through Services Australia, with your Medicare card and the receipt for the prosthesis. You buy the prosthesis first, then claim the reimbursement.

• Buy your external breast prosthesis and keep the receipt.
• Lodge a reimbursement claim with Services Australia, up to $400 per prosthesis.
• Claim again for replacements when the reimbursement renews on its cycle.

Read the official External Breast Prostheses Reimbursement Program guidance

Rule-Based Scenarios

Scenario 1: first prosthesis after surgery

A woman who has had a mastectomy for breast cancer buys an external breast prosthesis and claims reimbursement of up to $400 for it.

Scenario 2: bilateral mastectomy

A woman who has had a mastectomy on both sides claims up to $400 for each prosthesis, reflecting the need for one per side.

Scenario 3: replacement on the cycle

Some years later, the prosthesis has worn out. Because the reimbursement renews on a cycle, she claims again for a replacement.

Scenario 4: no income test

A woman with a comfortable income is reimbursed just the same as a low-income woman, because eligibility is based on having had the mastectomy, not on finances.

Common Mistakes

• Not keeping the receipt: the benefit is a reimbursement, so you need the receipt for the prosthesis to claim.
• Forgetting replacement claims: the reimbursement renews on a cycle — claim again when you replace a worn prosthesis.
• Claiming only one after a bilateral mastectomy: you can claim up to $400 for each prosthesis where you have had a mastectomy on both sides.
• Assuming there is an income test: there is none — eligibility is based on having had a mastectomy because of breast cancer.
• Thinking it covers implants: the program is for external prostheses worn in a bra, not surgical implants.
• Not claiming at all: many eligible women never lodge the claim, missing reimbursement they are entitled to.

Related Benefits

• PBS Safety Net — cheaper or free medicines after an annual threshold.
• Original Medicare Safety Net — higher Medicare benefits after a gap threshold.
• Health Care Card — concession access for cheaper medicines and services.
• Continence Aids Payment Scheme — help with the cost of continence products.
• Stoma Appliance Scheme — free or subsidised stoma products.
• Low Income Health Care Card — concession access for low-income earners.

Frequently Asked Questions