This is one of the most common questions we hear at the front desk, and the short answer is yes. You can absolutely use both Medicare and your private health fund at the optometrist. The key is understanding that they cover completely different things, so there is no conflict between them.
What Medicare Covers
Medicare covers the eye examination itself, meaning the clinical consultation with your optometrist. At Prime Optometrists Auburn, we bulk bill all eligible patients, so if you hold a valid Medicare card, your eye test is completely free. You pay nothing out of pocket for the consultation.
Medicare eligibility for bulk-billed eye tests is as follows:
- Adults under 65: once every three years
- Adults 65 and over: once every 12 months
- Children under 15: more flexible frequency
- People with diabetes, glaucoma, or certain other conditions: annually regardless of age
Not sure if you are eligible? See our full guide: What Is a Bulk Billed Eye Test and Am I Eligible?
What Your Health Fund Covers
Your private health fund optical extras cover eyewear, not the eye examination. This typically includes:
- Prescription spectacle frames
- Prescription lenses (single vision, bifocal, progressive)
- Prescription sunglasses
- Contact lenses and contact lens fitting fees
Health funds do not pay for the eye test consultation on top of Medicare. The consultation is already covered at no cost through bulk billing, so there is no gap for your fund to contribute to. The two benefits work side by side, not on top of each other.
How It Works in Practice
Here is what a typical visit looks like at Prime Optometrists Auburn:
- You bring your Medicare card and your health fund card
- We bulk bill the eye examination through Medicare, no charge to you
- If you need glasses or contact lenses, we process your health fund claim on the spot using HICAPS
- Your fund pays its benefit directly, and you pay only any remaining gap, if there is one
We accept all major Australian health funds including BUPA, Medibank, HCF, NIB, AHM, CBHS, Teachers Health, and Police Health. The HICAPS terminal is at the front desk, so claiming takes seconds.
Can I Claim the Eye Test on My Health Fund As Well?
No. Once Medicare has bulk billed your eye test, there is no remaining charge for your health fund to contribute to. You cannot claim the same service through two payers. However, because the test is already free through Medicare, this is not a disadvantage at all.
If you are not eligible for a bulk-billed test yet (for example, if you have already had one within the past three years and do not have a qualifying health condition), some health funds will contribute a set amount toward the out-of-pocket consultation fee, depending on your level of extras cover. Check with your fund before your appointment if this applies to you.
Maximise Your Optical Benefit
Most health fund optical benefits reset on 1 January each year. If you have unused optical extras from the current year, it is worth using them before they expire. A bulk-billed eye test plus a health fund claim on new glasses is one of the most straightforward ways to get genuine value from your private health cover.
For more on making the most of your optical extras, read our guide: How to Use Your Health Fund for Glasses Before It Resets
Book Your Eye Test in Auburn NSW
At Prime Optometrists Auburn, we bulk bill eligible patients and process health fund claims on the spot. Bring both cards, and we will take care of the rest.
Book your eye test online or call us on (02) 9761 0005. No referral needed.