The cost of eye care: What is covered by Medicare?

Oct 21, 2019
Having regular eye tests keeps your vision and eye health in great shape. Source: Getty

Going for regular eye check-ups is an important part of managing your health. But many of us continually put off having an eye test, either because of cost, forgetfulness or even fear.

But a visit to the optometrist doesn’t necessarily mean that you have to cough up too much cash. It turns out there are a number of government-funded programs that may be able to help you obtain a free eye exam and affordable glasses, Anthony Fleming, health expert at comparethemarket.com.au, tells Starts at 60.

“Our sight is something we can take for granted as our eyes typically don’t need much maintenance early on in our lives,” Fleming says. “However, it’s still important to care for our vision, and that means regular trips to the optometrist!”

Medicare and eye care

Medicare will cover the cost of a standard eye test every three years until you are 65. At that point, you are then eligible for a free eye test every year, he explains. If you have an eye disease that requires regular check-ups, such as glaucoma or diabetic eye disease, the cost will also be covered by Medicare. Fleming says the national scheme may also cover certain medically necessary services, such as cataract surgery.

However, Medicare doesn’t cover the cost of glasses and contact lenses. But the good news is, low-cost spectacle schemes are available in most states and territories.

“There are a number of government-funded programs that can assist seniors with their vision and overall eye health,” he advises.

Spectacle schemes and programs in Australia

New South Wales 

For example, the NSW Spectacles Program provides government funded glasses and vision aids to eligible people, including seniors, those living in rural areas and people with disability.

Queensland

South Australia

The Australian College of Optometry in South Australia provides comprehensive eye care, including diagnostic imaging services, for all patients with a Pensioner or Health Care Card. Meanwhile, under the GlassesSA program, pensioners are also eligible for cheaper frames.

Western Australia

The WA Spectacle Subsidy Scheme helps seniors who receive an age, disability or service pension, or hold a WA Seniors Card, obtain low-cost glasses, once every two years, with the subsidy maximum coming in at $53.85.

Victoria

Meanwhile, the Victorian Eyecare Service (VES) provides low-cost eye care and visual aids to people who hold a Pensioner Concession Card or who have held a Health Care Card for at least six months.

Australian Capital Territory

The ACT Spectacle Subsidy Scheme provides eligible residents – people who hold a Pensioner Concession Card from either Centrelink or the Department of Foreign Affairs, or who have held a Healthcare Card for three months or more – with a subsidy of up to $200 once every two years.

Northern Territory

The NT Concession Scheme helps eligible residents obtain a concession on spectacles every two years. Spectacle concessions can be used for either one pair of prescription reading glasses and one pair of distance glasses, or one pair of bifocal, multifocal or progressive glasses.

Tasmania

Meanwhile, Tasmania’s Spectacle Assistance Scheme helps eligible patients with the cost of specific types of lenses and frame.

Not eligible for public eye health programs?

If you’re not eligible for public eye health programs, you will need to seek eye care privately and health insurance can be a great way to cover the expense.

“Taking out a health insurance policy means you can claim on services that Medicare may not contribute towards like prescription glasses and prescription contact lenses, and that can make a big difference to your sight,” Fleming explains. “If you want to get covered for optical, you’ll need to first consider the extent of coverage you need.”

He says there are two main types of coverage for your vision: general optical, which typically includes prescription glasses and contact lenses (and even laser surgery at times), and major coverage, which includes cataract surgery and eye lens procedures.

Fleming adds one of the big benefits of getting private health insurance for optical “is that you may also be able to claim on subsidised prescription swimming goggles, and sunglasses”, however, there are some limitations to consider. For example, you can only claim a certain amount per year, and you may only be able to choose lenses or frames from certain stores and providers.

Important information: The information provided on this website is of a general nature and information purposes only. It does not take into account your personal health requirements or existing medical conditions. It is not personalised health advice and must not be relied upon as such. Before making any decisions about your health or changes to medication, diet and exercise routines you should determine whether the information is appropriate in terms of your particular circumstances and seek advice from a medical professional.

Info & tips to help you stay healthy and enjoy your 60's

Sign up to our weekly newsletter for more great health tips

Have you ever put off eye care services?

Please sign in to post a comment.
Retrieving conversation…