Medicare Information

Under Medicare you have complete freedom to choose any optometrist you want.

Eye Examinations and Medicare

You'll receive a Medicare rebate for your eye examination, with the exception of some contact lens consultations. If you have private health insurance you may also be eligible for benefits on the purchase of glasses and contact lenses. Your private health insurer can confirm your optical entitlements.

Medicare

Eye examinations given by optometrists are covered by Medicare for all permanent residents of Australia. All Australians qualify for optometric benefits without having to take out private health insurance.

Pensioners and the Disadvantaged

Medicare provides for optometrists to direct bill the government on behalf of their patients. This is also known as 'bulk-billing'. Most optometrists direct bill on behalf of pensioners and the disadvantaged. This means that people on low incomes can easily access quality eyecare without having to contribute from their own pockets.

Claiming Optometric Benefits

If your optometrist direct bills Medicare for your eye examination, you pay nothing for the examination. Medicare pays the optometrist 85 per cent of the fee that is set by the Government and that is accepted as full payment.

If you are billed for the examination you can claim optometric benefits under Medicare in two ways:

• Pay the account and claim a refund from your nearest Medicare office.
• Send the account to Medicare and receive in turn a cheque payable to the optometrist which you then pass on to the optometrist.

You will have to pay the difference between the account and the Medicare refund, but this difference will normally not be more than 15 per cent of the consultation fee. If you have consulted another optometrist within the past two years, Medicare may pay a lower level of benefit, depending on the clinical need for the consultation.

Optometrists Fees

Optometrists fees are determined through negotiations between Optometrists Association Australia and the Commonwealth Government. Unlike doctors, participating optometrists are not allowed to charge more than the agreed fees. They sign an agreement with the Government to this effect. Medicare normally pays at least 85 to 100 per cent of optometrists' fees.

Medicare pays for most consultations, however some consultations relating to the prescription of contact lenses are not covered. More information on these consultations and the conditions applying to them is available here.

Medicare Card

To ensure that you receive your Medicare refund quickly, present your Medicare card whenever you visit your optometrist, and whenever you claim benefits from Medicare. The card has your Medicare number and is proof that you are eligible for Medicare benefits. You will need to quote this number when making a claim. If your optometrist directly bills Medicare on your behalf you simply need to present your card when you have an examination.

Choice of Optometrist

Under Medicare you have complete freedom to choose any optometrist you want. Medicare pays for examinations by optometrists everywhere in Australia.

Spectacles, Contact Lenses and other Optical Aids

Private health insurance funds provide cover for spectacles, contact lenses and optical aids in their ancillary or 'extras' tables. These items are not covered by Medicare.

In most states pensioners and disadvantaged people can obtain optical aids free or at a reduced cost under State Government schemes. Ask your optometrist about these benefits.

Referral

You do not need a referral from a medical practitioner to receive Medicare benefits for eye examinations given by optometrists. You simply contact your local optometrist and arrange an appointment.

*Medicare information courtesy of the Optometrists Association of Australia