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Medicare

Family with two kids waiting for an optometrist

The information provided below is a guide to Medicare only, which can be a complex system and can frequently change.

If you have any concerns about Medicare, our staff will be able to help you understand what is covered by Medicare and private health insurance and what—if any— costs will be out-of-pocket.

Does Medicare Cover Eye Tests?

The Medicare system covers consultations with all optometrists. This means that Medicare can be used to cover eye tests offered by optometrists for all Australian permanent residents.

If the optometrist bulk bills, meaning the optometrist bills the government directly on your behalf, then you won’t have to pay for your consultation.

If the optometrist does not bulk bill, you will first pay the optometrist for the consultation and then claim your Medicare benefits by submitting a claim to Medicare.

Private health insurance does not cover consultations, however, for those with optical benefits, this can be used in the purchase of glasses and contact lenses. Your level of coverage will depend on your insurer and your level of coverage.

Eligible Medicare card holders under 65 years of age can claim the cost of an initial standard eye test on Medicare once every 3 years.

Those over 65 years of age can claim the cost of a full eye test once a year.

Medicare can also be used to cover subsequent and follow up eye tests.

However, if a patient experiences new symptoms (as a result of an eye injury, headaches or blurriness) or has a pre-existing condition which requires more frequent consultations (such as cataracts or glaucoma), they may be able to claim the full consultation more frequently.

Medicare covers the consultation fees associated with contact lenses only for specific prescriptions, over +5.00D, -5.00D and 3D of astigmatism, once every 3 years.

Does Medicare Cover Glasses or Contact Lenses?

Note that Medicare does not cover the cost of glasses or contact lenses.

Does Medicare cover eye surgery?

Medicare can subsidise consultations with private medical specialists, including eye surgeons and ophthalmologists. However, most medical specialists do not bulk bill, so there will be out-of-pocket fees. Usually the optometrist’s staff will be able to submit your Medicare claim on the day of your visit. Medicare can also partially cover the cost of eye surgeries, such as cataract or glaucoma surgery.

We recommend discussing all fees associated with medical care directly with the optometrist or staff to clearly understand what is subsidised and what will be your out-of-pocket cost.

All consultations and surgeries conducted in a public hospital should be fully covered by Medicare, however you might need wait weeks, months or even years for consultations and surgery. It is also important to know that in a public hospital, you will most likely be examined by and operated on by a medical resident, not a fully qualified and experienced eye surgeon

We understand Medicare can be difficult to navigate, so please do not hesitate to contact The Focal Point Optometrist in Wembley prior to your appointment, and our staff will be happy to discuss all insurance matters with you.

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