Funding for your Prosthesis

People are often concerned about the costs involved in getting a prosthesis. In Australia, there are a number of different funding schemes and it can be easy to get confused and to know what you are eligible for.

During the course of your treatment, funding for your prosthesis should be discussed with you. As the majority of amputations are due to contributing medical conditions such as diabetes, vascular disease or cancer; your prosthesis will generally be funded through the public health system, the National Disability Insurance Scheme (NDIS).

Content Image

Generally speaking, the following categories apply to prosthetic funding.

  • If you lost your limb due to disease or illness, you will most likely be covered by the public health system in your state or territory or the (NDIS) if you are 64 years or under.
  • If you lost your limb in an accident and there is no compensating body, then the public health system or the NDIS will cover the cost of prosthetic limb/s.
  • If your amputation was due to trauma, such as a motor vehicle or workplace accident, and compensation is identified as a possibility, the insuring organisation will most likely fund your prosthesis and medical needs.
  • Veterans who lost their limb as a result of injuries received while serving, and who have a Gold Card, will have their prosthesis paid for by the Department of Veterans Affairs (DVA) or the Defence Force.

Private Health Insurance rarely allocates funding for prosthetics, however it is worth checking with your insurer as they may cover partial costs.

Because there are different types of funding, the prosthesis, and other rehabilitation services you receive may depend on the cause of your amputation. Like many public health services, funding can be limited.

If you are funded by the public health system, you can make personal financial contributions toward your prosthesis if you want particular componentry that public funding does not cover.

If you are eligible for ongoing prosthetic funding, all future prosthetic services ranging from:

  • your first (interim) prosthesis
  • replacement prosthesis
  • socket replacements
  • reasonable repair and maintenance costs
  • and consumables like stump socks and shrinkers will be included.

There is a set requirement for how often your prosthesis and socket can be replaced. There are limitations on repairs and maintenance and limitations on manufacturers’ guidelines and expected periods of use for a component. However, if the prosthesis or socket needs changing before the usual time period, then your prosthetist provider may refer you back to your amputee clinic for further assessment.

Content Image
Ask your prosthetist to arrange for a trial of a prosthetic component to determine if it is the right one for you.

It is important to remember that you can trial most prosthetic devices before selecting the device that best meets your needs. Most prosthetic componentry companies will allow you to have a foot, knee unit or hand/arm on loan for approximately two weeks to try, before you make the final decision about which device is best for you. Trialling a component will give you the chance to see what works, what doesn't work, and if there are benefits that you were not aware of. A different foot, knee or arm unit could give provide you with better outcomes including:

  • more energy at the end of the day
  • providing you with more stability and confidence
  • enabling you to be more active
  • increasing your level of functionality
You are not limited by the number of devices you can try, but it is usually only two or three at the most.