Medicare*

Pensioners and the disadvantaged

Medicare provides for optometrists to direct bill the government on behalf of their patients. It is the policy of Optometrists Association Australia that members direct bill on behalf of pensioners and the disadvantaged. This means that people on low incomes can receive quality eye care without having to contribute from their own pockets.

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

If you are billed for the examination you can claim optometric benefits under Medicare in two ways:

1. Pay the account and claim a refund from your nearest Medicare office.
2. Send the account to Medicare and receive in turn a cheque payable to the optometrist which you then pass on to the optometrist.

You will have to pay the difference between the account and the Medicare refund, but this difference will never be more than 15 per cent of the consultation fee or $20.00, whichever is the lesser.

Optometrists' fees

Optometrists' fees are determined through negotiations between Optometrists Association Australia and the Commonwealth Government. Unlike doctors, participating optometrists are not allowed to charge more than the agreed fees. They sign an agreement with the Government to this effect. Medicare pays at least 85 per cent of this fee and the maximum you will ever have to pay is $20.00.

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Medicare card                                                                        

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 is proof that you are eligible for Medicare benefits. It has on it your number which you will need to quote 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, and to sign a form.

Choice of optometrist

Under Medicare you have complete freedom to choose any optometrist you want. Medicare pays for examinations by optometrists everywhere in Australia.

Spectacles, contact lenses and other optical aids

Private health insurance funds provide cover for spectacles, contact lenses and optical aids in their ancillary or `extras' tables.

In most states pensioners and disadvantaged people can obtain optical aids free or at a reduced cost under State Government schemes. Ask your optometrist about these benefits.

Referral

You do not need a referral from a medical practitioner to receive Medicare benefits for eye examinations given by optometrists. You simply contact your local optometrist and arrange an appointment.

*This page was reproduced with permission © Optometrists Association Australia