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The Ins and Outs of Optical Health Insurance in Australia

Whether you need new prescription glasses or want to book an eye test, you might be wondering how much Medicare will pay and if they’ll cover the costs of your chosen optometrist.
Fact Checked

Updated: 22 May 2024

Medicare does not usually cover eyeglasses and contact lenses. To avoid out-of-pocket costs, you might want to look for health insurance with optical cover.

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Does Medicare cover eye care?

If you have a Medicare card and go to an optometrist that is registered with the Optometry Board of Australia, Medicare will usually cover some of the costs for consultations on vision-related problems that are defined as clinically relevant. Benefits are generally payable at 85% of the Medicare Benefit Scheme (MBS) for optometry fees.

However, since 1 January 2015 optometrist can set their own prices, so you might have to pay more and there have been some changes regarding how often you can have a bulk-billed eye test:

Under the age of 65

A benefit is only payable once every 3 years.

65 years and older

A benefit is payable once every 12 months.

If you wear glasses or contact lenses, you know that your eyesight changes all the time, which is why it’s usually suggested you have an eye exam every year.

Optometric services not covered by Medicare, include:

How much is a typical eye exam without health insurance?

Without Medicare or private health insurance extras, a comprehensive initial consultation by an optometrist is generally $66.80. If you have a Medicare card, you’ll generally only pay $10 because they’ll cover 85% of the fee ($56.80). However, because optometrists can now set their own prices, you might be charged more. For example, a comprehensive eye test from Specsavers generally cost about $71.

Take note; Medicare benefit payments for the above are only valid if you’ve not gone for an eye test within the last 36 months when under 65, or last 12 months when 65 years and older.

You may need to have more frequent eye tests if you:

You might also want to get your child’s eyes tested before they start school, so that vision problems can be detected early on and not interfere with their learning ability.

Optical health insurance explained

Different extras policies and providers will provide different levels of coverage, waiting periods and benefit limits.

How to find the best health insurance for optical

Most private health funds provide extras that offer some level of optical coverage. However, the amount or percentage depends on the extras option you choose. You may want to consider your family dynamic, health, age and budget to help you find a policy that’s best suited to your requirements.

Below are some Australian health insurers that provide extras cover for prescription spectacles, contact lenses and eye exams.

Compare optical cover options

Insurer
Waiting period
Benefit limit