A question that comes up from every mastectomy customer is: "How much coverage do I get from BC Fair Pharmacare?" The answer unfortunately, is not a nice clear number.. rather it is a fairly general response.
Medical coverage in B.C. is calculated based on your family income, ie. you and your legal spouse. Fair Pharamcare is a deductible based system where there are several different levels. Your family moves to different levels of coverage depending on how much is spent on all eligible medical expenses. Note that there are caps on certain medical devices/expenses.
Fair Pharmacare Coverage levels:
Level 1. You pay 100% of all Medical expenses
Level 2. Pharmacare pays 70% of eligible Medical expenses (you pay 30%)
Level 3. Pharmacare pays 100% of eligible Medical expenses. Some expenses are capped (Mastectomy Breast forms are $450 each)
The maximum cap for mastectomy breast forms is $450 per side. Depending on which Level you are in, you could receive from a 0-100% refund. Note that mastectomy bras historically had some level of coverage, however they are no longer covered by Fair Pharmacare.
Note: Fair Pharmacare will not consider providing coverage for your Breast Prosthesis unless you are fitted by a registered Mastectomy Store.
To calculate your coverage and deductibles please check out the link to the Fair Pharmacare Calculator.
Here's a screen shot of a simple example for a single person income of $80,000:
A high income family generally will have trouble qualifying for reimbursement, however if your family also has high medical expenses, you may qualify for for some level of reimbursement. You should be aware that if you have extended medical, then your provider may have coverage for these needs, they might also top up any reimbursement that is provided by Fair Pharmacare.
Beware! It is very important that you contact Fair Pharacare first, before submitting any costs to your extended medicare provider. Often extended care providers will dis-allow your claim unless you have first been rejected by the public health care system in BC. We have heard of cases that once client was rejected by their extended care provider, they were not allowed to reapply the "right way".
We wish this was an easier system. The Fair Pharmacare system will support lower income and middle income families and/or those families that have excessive medical costs. High income families may have trouble qualifying unless they have very high medical costs.
For further information on mastectomy/medical refunds please click the following link:
Fair Pharmacare or Call: 604-682-7120