Ontario ADP Breast Prosthesis Coverage: A Complete Guide

If you've had a mastectomy or lumpectomy in Ontario, you may be entitled to a government grant toward your breast prosthesis - and many women qualify for years without realizing it.

Ontario's Assistive Devices Program (ADP) helps cover the cost of an external silicone breast prosthesis. This is one of the most common questions we hear at our boutique, usually phrased as "Does OHIP cover my breast form?" The short answer: not directly - but ADP does. This guide explains exactly how ADP works, how much you can receive, and how to claim it, step by step.

As Amoena Certified Mastectomy Fitters, we've helped hundreds of women in Ontario through this process, and we can help you with it at your fitting appointment too. Book a fitting or contact us and we'll walk you through it.

OHIP vs. ADP: Clearing Up the Confusion

Many people search "OHIP mastectomy coverage" and come away confused. Here's the distinction:

OHIP (Ontario Health Insurance Plan) covers your medical care - surgery, hospital stays, and physician visits. OHIP does not directly pay for an external breast prosthesis.
ADP (Assistive Devices Program) is a separate Ministry of Health program that provides a grant toward eligible assistive devices, including external silicone breast prostheses.

So if you're looking for help paying for your breast form in Ontario, ADP is the program you want.

Who Qualifies for the ADP Breast Prosthesis Grant?

To qualify, you must:

Be an Ontario resident with a valid Ontario health card, and
Require a breast prosthesis because of the partial or total absence of one or more breasts due to a mastectomy, a lumpectomy, a failed reconstruction after a mastectomy or lumpectomy, or a congenital deformity.

Your income is not considered for general eligibility.

You may not qualify if you already receive support for the same prosthesis from the Workplace Safety and Insurance Board (WSIB), or if you are a Group "A" veteran already receiving support from Veterans Affairs Canada for the same prosthesis.

How Much Does ADP Cover?

If your application is approved, you'll receive a grant of:

$195 per side for a full-breast prosthesis
$105 per side for a partial-breast prosthesis

If you receive social assistance through Ontario Works, the Ontario Disability Support Program (ODSP), or Assistance for Children with Severe Disabilities, you may be eligible for up to:

$260 per side for a full-breast prosthesis
$140 per side for a partial-breast prosthesis

The grant is a fixed amount, not a percentage. A quality silicone form usually costs more than the grant - the remaining cost is typically claimable through private or extended health insurance (more on that below).

What ADP Covers - and What It Doesn't

Covered: External silicone breast prostheses (full or partial), one per side.

Not covered by ADP:

Mastectomy bras
Swim prostheses and swimwear
Non-silicone or temporary (leisure) forms
More than one prosthesis per side
Silicone nipples, repairs, or maintenance

The good news: mastectomy bras, swim forms, and leisure forms are very often covered by private or extended health insurance. We provide the detailed receipts you'll need to claim them. Browse mastectomy bras and breast forms any time.

How Often Can You Get a New Prosthesis?

ADP will fund a replacement when either:

Your old prosthesis is worn out, 2 years have passed since it was approved, and it's no longer under warranty; or
You need a new prosthesis because of a change in your body size or shape, or a change in your medical condition.

ADP does not cover replacing a lost prosthesis or repairing one damaged through misuse.

The ADP Form: Application for Funding Breast Prosthesis Grant (4392-67E)

The form you need is the Application for Funding Breast Prosthesis Grant, form 4392-67E.

Download form 4392-67E from the Ontario Central Forms Repository

Your 3 Steps to Claim ADP

Get fitted by a trained fitter. ADP requires a fitting by qualified staff. Our Amoena Certified Mastectomy Fitters will confirm the right prosthesis for your surgery type and complete the vendor portion of your paperwork. Book your fitting.
Purchase your prosthesis and keep the receipt. You must pay the full cost up front. We provide an itemized receipt showing the product, our fitter's details, and its medical purpose. (Keep your receipt for 2 years.)
Submit your completed form. Send form 4392-67E with your original receipt to the ADP by:
- Email: assistivedevicesprogram@opddp.ca
- Fax: 416-327-8192
- Mail: Assistive Devices Program, 5700 Yonge Street, 7th Floor, Toronto, ON M2M 4K5

ADP aims to review applications within 8 weeks, and if approved, you'll receive funding within 30 days of the decision. You can set up direct deposit for faster payment.

Ready to use your ADP coverage? Book a fitting

Combining ADP With Private Insurance

Because the ADP grant is a fixed amount, most women combine it with private or extended health benefits to cover the rest - including the prosthesis balance and mastectomy bras. A common approach is to use your ADP grant first, then submit the remaining out-of-pocket cost to your private insurer.

Before you claim, it helps to check:

Does your plan cover external breast prostheses and/or post-mastectomy bras?
Is your coverage a set dollar amount or a percentage?
Does your insurer require you to use ADP first?

To claim through private insurance, you'll generally need a prescription from your doctor or surgeon stating the need for an "external breast prosthesis" and/or "post-mastectomy bras," plus a detailed receipt - both of which we help you with.

What If My ADP Claim Is Denied?

A denial usually means information is missing, not that you're ineligible. Common reasons include a missing signature, an incomplete form, or a receipt that doesn't clearly identify the item as a breast prosthesis. Read the denial letter carefully, call the number provided to confirm exactly what's needed, and resubmit. We're happy to provide a more detailed receipt or product description to support your claim, and ADP decisions can also be appealed.

Frequently Asked Questions

Does OHIP cover breast prostheses in Ontario?
Not directly. Ontario's support for external breast prostheses runs through the Assistive Devices Program (ADP), not OHIP.

How much will ADP pay for my breast form?
$195 per side for a full prosthesis and $105 per side for a partial prosthesis, with higher amounts ($260 / $140) for those on Ontario Works, ODSP, or Assistance for Children with Severe Disabilities.

Does ADP cover mastectomy bras?
No - ADP covers the silicone prosthesis only. Mastectomy bras are usually covered by private or extended health insurance.

Do I need a prescription for ADP?
You need a fitting by qualified staff and the completed ADP form. A physician's prescription is generally required for private insurance claims, and it's good practice to have one on file.

How often can I get a new prosthesis through ADP?
Generally once every 2 years, or sooner if your body shape or medical condition changes.

Program rules and amounts can change and are set by the Ministry of Health. Always confirm current details with ADP if anything is unclear - or ask us and we'll help you verify.

We'll Help You Through Every Step

You don't have to navigate ADP alone. At your fitting, we confirm the right prosthesis, complete the vendor paperwork, and give you an itemized receipt ready to submit. We offer in-person fittings in Barrie and virtual certified fittings for clients across Ontario.

Book Your Certified Fitting Browse Breast Forms