Medicare-eligible

Breast Forms and Insurance Coverage

Breast forms are medically eligible for breast cancer patients, particularly after a mastectomy. With a doctor’s prescription, they are often covered by insurance as they are considered medically necessary under U.S. laws such as the Women’s Health and Cancer Rights Act (WHCRA). This law ensures coverage for reconstructive surgery and external prostheses following a mastectomy.

Replacement and Insurance Eligibility

Insurance policies, including Medicare, generally cover the replacement of breast prostheses based on their expected lifespan or if they become defective. Typical replacement cycles include:

• Silicone prostheses: every two years
• Foam or fiber-fill forms: every six months

Medical Necessity

Although breast reconstruction itself may not always be deemed medically necessary, the right to obtain a breast prosthesis is protected by law. This ensures that all mastectomy patients have access to restorative options that support comfort, symmetry, and confidence.

Documentation Requirements

To qualify for insurance or Medicare reimbursement, you’ll need proper documentation from your physician. Some insurance providers may also request additional verification before approving coverage, so it’s important to confirm specific requirements with your plan.

Medicare-eligible. "Insurance providers may cover the cost of post-operative garments, pocketed bras, and breast prosthesis, also referred to as breast forms." Call your Insurance provider to verify your coverage. Although most major medical insurance policies cover mastectomy products within specific guidelines, you will need to contact your provider directly. 
Many insurance plans will cover one breast prosthesis (breast form) per year and two to four mastectomy bras per year, provided that you submit a prescription from your physician. Also many post-surgical camisoles are considered medically necessary.

We do not file insurance, but we will provide a receipt that is accepted by most insurance companies. 

We are not a Medicare provider.