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

Jun 19, 2021
Having regular eye tests can prevent further damage to your sight as you age. Source: Getty

Managing our eye care can become costly as we age and the need for eye exams and prescription glasses increases, but government-subsidised programs and Medicare benefits are available to help.

Going for regular eye check-ups is an important part of managing your health, but many of us put off having an eye test over fear we’ll be left with unaffordable out-of-pocket costs.

But a visit to the optometrist doesn’t necessarily mean you’ll have to cough up a whole lot of cash. There are a number of government-funded programs that may be able to help you obtain a free eye exam and affordable glasses.

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.

Spectacle schemes and programs in Australia

New South Wales 

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

Spectacle Supply Scheme: Provides Queenslanders with a pair of basic prescription glasses, once every two years.

South Australia

The Australian College of Optometry: Provides comprehensive eye care, including diagnostic imaging services, for all patients with a Pensioner or Health Care Card. Pensioners are also eligible for cheaper frames under the GlassesSA program.

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.

Victoria

Victorian Eye care Service: 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

ACT Spectacle Subsidy Scheme: Provides those with a Pensioner Concession Card or a Healthcare Card 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.

Tasmania

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, your options are to pay full price at the check out or take out private health insurance.

Anthony Fleming, health insurance expert at Compare The Market, says most private health funds cover a considerable amount of eye care fees.

“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.”

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 LEGAL INFO This article is of a general nature and FYI only, because it doesn’t take into account your personal health requirements or existing medical conditions. That means it’s not personalised health advice and shouldn’t be relied upon as if it is. Before making a health-related decision, you should work out if the info is appropriate for your situation and get professional medical advice.

Do you wear glasses? How often do you get your eyes checked?

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