Use It or Lose It: Medicare and Health Funds for Eye Care
Living in Belrose, a family-friendly community with growing screen time habits, dry weather conditions, and a mix of school-aged children and ageing parents, means having access to local eye care you can count on. But even when access is good, not knowing which services are covered by Medicare and health funds can often delay the care you need.
What Eye Care Services Are Covered by Medicare?
In Australia, Medicare typically covers a portion of optometry services, but some limits catch people off guard. If you’ve asked, “Does Medicare cover eye care?” the short answer is: yes, but only some of it. Here’s what’s usually included:
One bulk-billed comprehensive eye test every 3 years if you’re under 65
One bulk-billed comprehensive eye test every 12 months if you’re 65 or older
Coverage for specific diagnostic tests (like retinal imaging) when deemed medically necessary
Eye care appointments related to chronic conditions like diabetes, glaucoma, or macular degeneration
Urgent eye care assessments if you’re experiencing vision changes or discomfort
However, Medicare does not cover prescription glasses, contact lenses, ortho-k fittings, dry eye treatments, or elective tests that fall outside its definition of medically necessary.
What About Private Health Funds?
Private health funds can fill the gaps Medicare leaves behind, especially for optical extras. If you’re one of the many Belrose families juggling school, sports, and screen-heavy jobs, your private plan may be the best way to get covered services like:
Prescription glasses or sunglasses
Contact lenses, including options for children
Preventive treatments like myopia management
Follow-up appointments not fully covered by Medicare
Premium lens options and additional comfort features
Most private plans operate on an annual benefit cycle, resetting on 1 January. If you haven’t claimed your yearly eyewear allowance yet, now is the time. That’s where the “use it or lose it” message really matters. Once your plan resets, you can’t claim last year’s unused balance.
Making the Most of Your Vision Benefits Before They Reset
Your Medicare and private health fund benefit eligibility isn’t just about what you’re covered for; it’s about when and how you use them. The key is knowing how your Medicare eye care benefits work alongside your private health fund, and taking action before your plan resets.
Know When Your Plan Resets
Most Australian health funds reset on 1 January. That means benefits for glasses, contact lenses, and optical extras don’t roll over. If you haven’t used your annual allowance, it will disappear; no refunds, no credits, just gone.
If you’re eligible for Medicare as well, you’ll still have access to covered services next year, but your claimable extras under your fund won’t stack.
Understand the Role of “Secondary Payer”
When both Medicare and your health fund can cover a service, Medicare is considered the primary payer, and your fund becomes the secondary payer. This means Medicare will cover what it can first, and your fund may help with the rest, depending on your level of cover.
Know What You Can Claim
Whether you’re part of Original Medicare or have a Medicare Advantage Plan, it’s crucial to understand what counts as covered services under your particular plan. Always check:
Are children’s glasses or ortho-k lenses included?
Can you claim on contact lens fittings or rechecks?
Do you need a referral for more advanced testing?
Some health plans offer more generous allowances than others. If you’re unsure, bring in your plan details to Forestway Optometry Glenrose, and we’ll help you figure it out.
Consider Your Family’s Eye Care Needs
Think beyond your own needs. Is your child squinting more at school? Is a family member overdue for a check-up? Has your partner been putting off updating their frames?
Use Your Vision Insurance in Belrose: Now is the Best Time
Taking care of your eyes is essential, and it doesn’t need to be expensive or confusing. Whether you’re navigating Medicare and eye care for the first time or managing health benefits for the whole family, Forestway Optometry Glenrose is here to help you get the most from every visit.
Book your comprehensive eye exams to use your vision health benefits now, while you still can.