Medicare, Insurance & Laser Eye Surgery

Looking after your eyesight is essential to enjoy the best possible quality of life in the short and long term. To make this possible, there is financial support available for eye tests, and people with private health insurance can claim a rebate on contact lenses and glasses. But what about laser eye surgery? You might be wondering, does Medicare cover laser eye surgery? Let’s find out what optical health funding you may be eligible for and whether laser eye surgery is covered by Medicare or private health insurance.

How Many Eye Tests Does Medicare Cover?

Medicare provides a free comprehensive eye test through an optometrist every three years for Australians under 65 years old and every year for those over 65. If you have an eye condition such as glaucoma, you can have an eye test when required. However, if you’re curious how often you can get your eyes tested under Medicare in Australia, the guidelines are clear, but some exceptions may apply depending on your eye health needs.

 

Eye tests allow for determining the patient’s ability to see short and long distances. Known as a visual acuity test, it involves patients naming letters, numbers, or shapes on a chart. A peripheral vision test checks vision out of the corner of the eye. If the visual acuity test reveals the need for a glasses or contact lenses prescription, refraction testing diagnoses if a patient has short-sightedness or long-sightedness.

 

The optometrist will look at the front of the eye to check the condition of the cornea, lens, and iris, and at the retina, blood vessels, and optic nerve in the back of the eye.

 

An intraocular pressure (IOP) check helps detect if the pressure in the eye is high, which may suggest the patient has glaucoma, and digital retinal photography (DRP) helps catch serious eye conditions and diseases. The digital camera takes a photo of the back of the eye to pick up any issues that can cause irreversible damage if not treated early. The test can detect macular degeneration, retinal detachments, artery occlusion, optic stroke, diabetes, high blood pressure, and glaucoma. The eye’s photo can be kept on file and reviewed by an optometrist during future appointments to check for any changes in the eyes. DRP is not available as part of the bulk billed test and may be charged separately by the optometrist. Before your appointment, ask your optometrist about the tests they will conduct and for details of any out-of-pocket expenses. Are eye tests covered by Medicare when it comes to more complex procedures? It’s essential to know that not all tests might be included.

 

Moreover, the bulk-billed comprehensive eye test doesn’t cover consultations with an optometrist for contact lenses, visual field tests, or dry eye issues. Medicare doesn’t cover the cost of glasses or contact lenses.  Does Medicare cover eye tests that involve more advanced diagnostics? Typically, additional fees might apply for these services.

What Optical Benefits Does Private Health Cover?

People with private health extras cover can claim for part of the cost of their glasses, contact lenses, or prescription sunglasses. Most health funds don’t roll over any unused benefits, so it’s best to ask the health fund when the benefits renew so you can’t gain the most value from your policy. 

 

The amount you can claim will depend on the health fund and type of policy. Ask your fund for details. If you’re considering taking out a new health insurance extras policy, ask for details of their optical cover to decide which fund is best for you. If you wear contact lenses or glasses, there’s usually an annual limit for claims, which can vary widely between health funds.  

 

Some health funds allow members to claim for additional eye tests or tests that aren’t bulk-billed, but not all. For those considering future procedures, it’s also worth asking, is LASIK covered by Medicare or private insurance?

 

Cataract surgery involves removing a cataract and replacing it with an artificial lens. It is a minor hospital treatment that’s common in older Australians, but many find their policy doesn’t cover it. Check with your health fund if you think you may need surgery in future. If you’re concerned about costs, check if your policy includes bulk-billed cataract surgery or if there will be additional fees

Is Laser Eye Surgery Covered?

Is laser eye surgery covered by Medicare? Unfortunately, the answer is no. Medicare doesn’t cover laser eye surgery, and few private health funds offer a rebate on some types of surgery (not all). Generally, the top Extras policy is required, and a waiting period applies. The rebate may be a dollar amount per eye, and a lifetime limit may apply. 

 

While you may not be able to claim any treatment or only a portion of the cost of laser eye surgery, when doing the math it works out very well. On one hand, the upfront cost is high. However, when patients add up what they spend on glasses, prescription sunglasses, contact lenses, and saline each year, laser eye surgery is a worthwhile investment. As many patients say, you can’t put a price on the freedom of not having to wear glasses or contact lenses regularly.  

 

For patients who prefer to spread out the cost of their laser eye surgery, interest-free payment plans are available.

Eye Tests For Laser Eye Surgery

Laser eye surgeons need to do several tests before any kind of laser eye surgery. The tests check the eyes’ health and determine which type of laser eye surgery is more suitable. The measurements taken during the tests will also help during treatment.  

 

The tests include:

  • corneal shape
  • composition of the cornea
  • intraocular pressure
  • refraction to confirm glasses prescription
  • lubrication of the eye

 

Further eye tests are conducted after surgery to check the progress of the patient’s vision and the eyes’ condition to ensure they have healed and discuss any experienced symptoms.

Tips for Optical Health Expenses

See our top tips for looking after your eyes and your hip pocket. 

  • If you’re unsure when your last eye test was, try contacting the optometrist you last visited. If you’re under 40, a test every two to three years is recommended. For people over 40, it should be at least every second year, and people over 65 should have an annual eye test. If you have a family history of glaucoma or other risk factors, your optometrist or GP may recommend more regular checks at any age. 
  • If you’re unsure if you’re eligible for a bulk-billed eye test, ask your optometrist.
  • If you’re at risk of needing eye surgery, your GP or optometrist will refer you to an ophthalmologist. The cost of the appointment won’t be bulk billed, so make sure you ask about costs before your appointment. 
  • Considering laser eye surgery in the future and looking for a health insurance policy? Do your research, as the rebates paid by the different private health insurers can vary widely. Also, consider any waiting period you will need to serve. Additionally, check if your policy offers any coverage under the top Extras, even though Medicare does not cover laser eye surgery.

 

For more information about laser eye surgery and possible costs schedule a consultation today! If you want to know if you’re a good candidate for laser eye surgery, you can take our suitability test.

Contact Lions Laser Vision

Please call us at Lions Laser Vision and speak with one of our clinical coordinators who will be able to answer your questions and schedule an initial consultation with one of our refractive surgeons.

Alternatively, complete the form below and we will get back to you as soon as we can.

PHONE: 08 9381 0758
FAX: 08 9381 0700

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Lions Eye Institute

Lions Laser Vision
1st Floor,
2 Verdun Street
Nedlands WA 6009

St John of God Murdoch
Murdoch Medical Centre

Suite 4B,
Ground Floor,
100 Murdoch Dr
Murdoch WA 6150