Does Medicare Cover Contact Lenses in Australia? The Clear Answer

Medicare in Australia covers comprehensive eye examinations under certain conditions,but it does not cover the cost of contact lenses or contact lens fitting fees. This is one of the most frequently misunderstood aspects of Medicare optical coverage. Here is a clear breakdown of what is and is not covered.

What Medicare Does NOT Cover for Contact Lenses

• Contact lens supply (daily, fortnightly, monthly, or annual lenses)
• Contact lens fitting fees
• Contact lens follow-up appointments specifically for contact lens assessment
• Specialty lens fittings (scleral, orthokeratology, multifocal contacts)

What Medicare DOES Cover

• The comprehensive eye examination that includes assessment of whether contact lens wear is appropriate (this examination is bulk billed)
• Pathology or treatment of conditions affecting contact lens wearers (e.g., corneal abrasion from a lens, infectious keratitis),assessed under therapeutic consultation item numbers

Private Health Fund Coverage for Contact Lenses

Many private health funds with optical extras do provide a benefit toward contact lenses. The benefit amount varies significantly by fund and level of cover. Typically, optical extras provide a single annual benefit that can be used toward any combination of glasses and contact lenses. HICAPS is processed on the spot at our Auburn clinic,you pay only the gap (if any) at collection.

NDIS and Contact Lenses

NDIS participants may have contact lens costs covered under their plan in specific circumstances,particularly when contact lenses are required for the management of a vision condition that is directly related to the participant's disability (e.g., keratoconus requiring scleral lenses). This requires NDIS plan support and prior arrangement,contact us to discuss your specific situation.

DVA (Department of Veterans' Affairs)

DVA Gold and White Card holders may have contact lens costs covered under DVA arrangements. Eligibility depends on card type and the clinical indication for contact lenses. We process DVA claims directly at Prime Optometrists Auburn.