Medicare Claims and Rebate Eligibility

Eye examinations provided by optometrists are subsidised by Medicare for all permanent residents of Australia.

Rebate Eligibility

All Australians qualify for optometric benefits without having to take out private health insurance. Depending on where you are at in your rebate cycle you may receive a Medicare rebate for your eye examination, with the exception of some contact lens consultations.

You will receive Medicare benefits for eye examinations, except for some contact lens fitting consultations and some examinations that test your visual fitness to drive, fly or be employed by organisations such as the Australian Defence Forces.

If you have private health insurance you may also be eligible for benefits on the purchase of glasses, contact lenses and other optical aids. Your private health insurer can confirm your optical entitlements. In most states pensioners and certain disadvantaged people can obtain optical aids free or at a reduced cost under State Government schemes. Ask your optometrist about these benefits.

Bulk Billing

Optometrists can direct bill the government on your behalf. This is also known as 'bulk-billing'. Many optometrists direct bill on behalf of pensioners, children and those with limited financial means. This means that all Australians can easily access quality eyecare without having to contribute from their own pockets.

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

Claiming from Medicare

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.

If your optometrist does not bulk bill you can claim Medicare benefits by submitting a claim to Medicare just like you would when you see the doctor. You will have to pay the difference between the account and the Medicare refund, usually 15%, but this can be higher.

Sometimes your optometrist may recommend additional testing, such as digital retinal photography that is not eligible for a Medicare rebate, but is recommended in the best interests of your eye health.

^Medicare information courtesy of the Optometry Australia