Insurance
Insurance coverage guide
Most health insurance plans, including Medicare, cover medically necessary breast prostheses and mastectomy bras. We help you understand your benefits, gather the right documents, and submit claims so you can focus on recovery.
How the process works
Verify coverage
Call your insurance or check your plan documents for DME (durable medical equipment) benefits. We can help you ask the right questions.
Get a prescription
Ask your surgeon or oncologist for a written prescription specifying mastectomy bras and/or breast prosthesis as medically necessary.
Submit and track
Purchase your products, then submit the itemized receipt and prescription to your insurance. We provide properly coded receipts with HCPCS codes.
Your rights under WHCRA
The Women's Health and Cancer Rights Act (WHCRA) is a federal law that requires group health plans covering mastectomy to also cover breast reconstruction, prostheses, and treatment of physical complications. This means your plan cannot deny coverage for mastectomy bras or breast forms if it covers the surgery itself.
If your claim is denied, you have the right to appeal. We can help you prepare the documentation needed for a successful appeal.
Medicare coverage
Medicare Part B covers breast prostheses (external breast forms) and mastectomy bras as durable medical equipment. You are typically covered for one breast prosthesis per side every two years and up to six mastectomy bras per calendar year. A prescription from your doctor is required.
Frequently asked questions
Does insurance cover mastectomy bras?
Yes. Under the Women's Health and Cancer Rights Act (WHCRA), group health plans that cover mastectomy must also cover prostheses and bras. Medicare Part B covers mastectomy bras (up to 6 per year) and breast forms as durable medical equipment.
How many mastectomy bras does insurance cover per year?
Medicare covers up to 6 mastectomy bras per calendar year. Private insurance varies by plan, but most cover between 2 and 6 bras annually. Check your specific plan's DME benefits for exact coverage.
Do I need a prescription for insurance to cover my breast prosthesis?
Yes. You will need a written prescription from your doctor for both breast prostheses and mastectomy bras. The prescription should include your diagnosis code and specify the items as medically necessary.
What is WHCRA and how does it protect me?
The Women's Health and Cancer Rights Act (WHCRA) is a federal law that requires group health plans covering mastectomy to also cover reconstruction, prostheses, and treatment of physical complications including lymphedema. This applies to most employer-sponsored plans.
Can I get reimbursed if I already purchased a mastectomy bra out of pocket?
In many cases, yes. Keep your itemized receipt with product descriptions and HCPCS codes. Submit the receipt along with your prescription to your insurance company. We provide properly coded receipts to make this process easier.
We are here to help with your claim
Navigating insurance can feel overwhelming. Randi has helped hundreds of women get their benefits covered. Book a free call and we will walk through your benefits together.
Need claim support now?
Call (610) 721-2794 and we can walk your benefits with you.