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If you get breast cancer when you retire and need a breast prosthesis, you have to dig deeper into your wallet.
A so-called breast prosthesis costs around 400 francs. This is worn outside the body in a special bra. The prosthesis is made of silicone and wears out within a year. Breast cancer patients who need such a prosthesis therefore need a new one every year.
The IV pays before you retire – after that the health insurance company pays
If a woman falls ill with breast cancer before the AHV age and has to remove a breast, the IV will cover the cost of a prosthesis. The IV pays a maximum of 400 francs per calendar year for this. The consultation is included in this fee. In this case, the IV will assume the costs for life.
If a woman of AHV age develops breast cancer, the health insurance company will cover the costs for the breast prosthesis. Until September 2021, health insurers paid 360 francs for a prosthesis, since October 2021 only 190 francs per calendar year, i.e. just over half. “It annoys me – there is saving on the shoulders of patients of AHV age,” says a person affected in the SRF consumer magazine “Espresso”.
BAG adapted cost coverage for health insurance companies
The Federal Office of Public Health (BAG) sets the tariffs that health insurance companies must pay for medical aids. In October 2021, the corresponding tariffs for breast prostheses were adjusted. There used to be a flat rate of 360 francs for prosthesis and advice. The health insurance company now pays CHF 190 for the prosthesis and CHF 150 for the consultation in the first year. This amount for the consultation is higher in the first year because the patient has to be instructed, which takes longer and is therefore reimbursed with a larger amount. In the years that follow, less advice is needed, says the BAG, since the patient already knows how to use the prosthesis. The health insurance therefore only reimburses CHF 37.50 for the consultation from the second year.
BAG considers “minor” differences to be justifiable
For affected patients, this means that while the costs of a prosthesis (400 francs) used to be almost completely covered by health insurance, today they still receive 190 francs for it, and they pay the rest out of their own pockets – deductible and deductible not included. If breast cancer is diagnosed before retirement age is reached and the IV then covers the costs for the prosthesis, all costs are covered.
The BAG argues that due to the different objectives and the systemic differences, “the slightly different prices (tariffs) in the various branches of social security are generally considered to be justifiable”.
The BAG’s decision shocked us – it affects pensioners who often do not have a bed of roses financially.
“Women of AHV age are discriminated against”
The Swiss Cancer League and other organizations that work for women with breast cancer see things very differently. “Women of AHV age are discriminated against when it comes to the remuneration of breast prostheses,” says Franziska Lenz, head of politics at the Cancer League. And Donatella Corbat, President of Europe Donna Switzerland: “The BAG’s decision shocked us – it affects pensioners who often do not have a bed of roses financially.”
The organizations now want to apply to the responsible commission of the BAG to change the positions mentioned. The Federal Council also has to deal with the issue after a request from the Council of States.