Good vision is easy to overlook until problems arise. Got questions about eye tests and insurance coverage in Australia? Here’s what you need to know about visiting your optometrist and the costs involved.

SUMMARY

  • Depending on your age and specific conditions, Medicare covers most eye tests every 12 months (if you’re 65 or older) or every 3 years (if you’re under 65)
  • If you don’t have Medicare coverage, expect to pay around $60 to $70 for an initial consultation.
  • Many eye tests are bulk billed with no out-of-pocket expenses if you’re covered by Medicare.
  • While usually not covering eye tests, optical private health insurance can cover up to 100% of the costs of prescription lenses, frames, or contact lenses, depending on your policy.

Your eye health is a crucial part of your general health, and taking care of them should be a top priority. Thankfully, when it comes to looking after your eyes, Medicare covers many of the necessary eye tests and exams.

However, if you wear glasses or contacts, you’re on your own, as Medicare doesn’t cover those. That’s a gap that can hit the wallet pretty hard, especially for glasses and contact lens wearers.

The good news is joining a health fund provider could be a smart way to take care of your eyes without breaking the bank.

Cost of An Eye Test with Medicare Cover

If you’re an Australian resident covered by Medicare, some of the cost of your eye test will be taken care of, provided it’s done by an optometrist registered with the Optometry Board of Australia. Here’s what you should know:

  • Clinical Relevance: Your eye exam must be related to real vision problems. This isn’t for routine checks but specific concerns.
  • Age Factors: If you’re under 65, you can use this benefit once every three years. If you’re 65 or older, it becomes available once every 12 months.
  • Cost Coverage: Medicare typically pays up to 85% of the optometry fees, as per the Medicare Benefit Scheme (Fraser, 2020). This helps to ease the financial burden.
  • Optometrist Pricing: Optometrists set their own prices, so the actual amount you’ll have to pay might vary. It’s wise to check with your optometrist first to find out the exact cost.

How Much is an Eye Test Without Medicare?

An eye test isn’t as expensive as you might think, even without Medicare or private health insurance. Typically, it’s around $60 to $70 for an initial consultation. How often you’ll need to pay this depends on several factors. Some people only need to pay this once a year, while others might need more visits to their friendly optometrist. Here’s why you might need more eye tests:

  • Medical Conditions: If you’ve got cataracts, glaucoma, or other conditions that affect your vision, you’ll need to keep a close eye on things.
  • Vision Problems: Distorted or blurry vision? That’s another reason you might need more frequent visits.
  • Retinal Issues: Something like a retinal detachment needs regular monitoring too.

Are Eye Tests Bulk Billed?

If you’re an eligible Medicare card holder, eye examinations are completely covered under the Medicare rebate. Here’s how it works:

  • Under 65? You’re eligible for one bulk-billed* comprehensive eye test every three years.
  • 65 or older? You can have one bulk-billed* comprehensive eye test every year.
  • Dealing with an eye condition like glaucoma? You can have an eye test as required, and it’s usually bulk-billed*.

Bulk-billed* simply means no out-of-pocket expenses for these services. It’s all about keeping your eyes in check without breaking the bank.

*Conditions apply, so always check with your provider.

Are All Eye Test Costs Covered by Medicare?

Medicare does not cover all eye tests – it covers mostly standard eye tests. More specialised eye tests, or consultations for contact lenses, visual fields or dry eye may cost you.

For example, Digital Retinal Photography isn’t covered by Medicare, but it may be covered by your health provider (it’s free with Bupa Optical – so every customer can access the tool to help detect any potential diseases that could threaten their vision).

How Does Private Health Help With Optical Care?

While private health insurance doesn’t cover your general eye tests, you could get up to 100% back on lenses, frames, or contacts, depending on your policy.

For example, with nib’s Core Extras you get:

Specsavers also partners with a range of Australian health funds, so with your private health insurance eyewear deals like

  • 2 designer pairs at no gap from the $199 single-vision range
  • 2 pairs at no gap from the $199 designer range, including standard lenses.
  • 25% off 1 pair from the $149 range or above.

And if you have a valid prescription, you can buy glasses or contacts online and make a claim through your Health Fund’s website. Simple and straightforward.

What Kind of Health Insurance Do You Need to Access These Benefits?

For optical benefits like coverage for prescription glasses, frames, or contacts, you’ll typically need to have a private health insurance policy with extras or ancillary cover. Here’s how it breaks down:

  1. Basic Health Insurance: Usually won’t cover optical benefits.
  2. Extras or Ancillary Cover: This is where you’ll find optical benefits. It’s designed to cover services outside the hospital, like dental, physiotherapy, and yes, optical care.
  3. Comprehensive Cover: Some comprehensive policies combine both hospital and extras cover, including optical.

Keep in mind that the level of optical coverage can vary widely between policies. Some might offer substantial rebates on glasses and contacts, while others may provide more limited benefits.

Always check the specific details of any policy you’re considering to ensure it meets your needs for optical care. If glasses and contacts are a regular expense for you, this might be a crucial part of your decision-making.

Seeing an optometrist with Health Insurance

Private health insurance can indeed be a game-changer when it comes to optical care expenses. Here’s a simple breakdown:

  1. What It Covers: With the right level of cover, things like prescription glasses or contact lenses may be completely covered or available at a reduced cost.
  2. Waiting Periods: You’ll want to make sure any waiting periods have passed to take advantage of these benefits.
  3. Not All Policies Are Created Equal: The specifics can vary widely between providers and even different policies within the same provider. Some might offer generous optical benefits, while others might cover only a fraction of the costs.
  4. Know Before You Go: Before you head to the optometrist, take a moment to review your policy’s details or even give your provider a quick call. That way, you’ll know exactly what to expect and can plan accordingly.

In other words, a little bit of time getting to know your policy can go a long way in keeping those eye care costs in check

Why Do You Need Your Eyes Tested?

Regular eye tests aren’t just about updating your glasses. They’re about catching problems early, like myopia, which is set to affect over half the world by 2050. Early detection can slow down conditions like this.

Even though most Australians know the importance of regular eye checks, 35% still skip them, and 12% have never seen an optometrist. Don’t be part of the statistics! Especially since 90% of vision loss in Australia can be stopped or fixed if caught early. Your eyesight is precious – take care of it.

Where Can You Get an Eye Test?

Your GP might check your eyes, but optometrists are the specialists here. They’ve got the education and qualifications to really dig deep into how your eyes are doing. You can find them in private practices or larger franchises, often in shopping centres.

What Can an Eye Test Diagnose?

These tests aren’t just about reading letters off a board. They check your eye muscles, the inside and outside health of the eye, your field of vision, and even the pressure inside your eye to spot things like glaucoma. It’s a full health check-up, but just for your eyes.

How Often Should You Have Your Eyes Tested?

Vision Australia recommends a check-up every two to three years for most folks. But if you’re having vision changes or headaches, get in sooner. And if you’re under 65, Medicare might even help with the cost.

As we get older, our risk goes up for eye conditions, so regular checks are even more essential. If you have a risk factor like smoking or a family history of eye disease, get in at least every two years

FAQs

What happens during vision testing?

Vision testing assesses your ability to see clearly at different distances and angles. It includes reading letters or symbols, checking eye muscles, examining the inside and outside of the eye, and may include special tests for conditions like glaucoma.

Is private health insurance worth it for optical care?

Private health insurance for optical care can be worth it if you frequently need new glasses or have specific eye health needs, as it may cover part or all of the costs of prescription lenses, frames, or contact lenses.