Eyes,Medicare,Bupa et al, Health Funds, Openpay
Medicare rebates are for the common eye examinations for the private and public patient. Health fund rebates are for optical appliances.
No Gap health fund options exist. Government means tested free glasses. Your medicare card is required for direct billing or bulk billing and to check on your eligibility. The Medicare card is usually green in colour, although interim cards are light blue and cards for Reciprocal Health Care Agreement visitors are light yellow. The Medicare Benefits Schedule (MBS) is a listing of the Medicare services subsidised by the Australian government including eye doctors and some allied health professions.
Openpay provision means buy now pay later interest free, for certain services.
Major funds such as Cua,Bupa,Medibank,Budget Direct,Ahm,Hcf,Nib,Hbf,Medibank Private,Defence health,Australian unity,Cbhs and Bupa optical among others lets you update your eye wear through the health funds extras cover policies. These annual maximum limits reset each year which, for most funds, 1 January but some on the financial year, or date of joining. Some funds such as Police Health and Emergency Services Health – let you claim unused benefits for some services during the next year.
As part of government reforms, Health Insurance prices, terms and conditions changed on April 1st 2019.
The private health industry is regulated by the Australian Government although rules regarding membership vary between funds and in some cases will vary between states.
All health funds have certain waiting periods and other conditions that apply before benefits are payable.
- Prescription glasses and contact lenses
- Rebates on prescription sunglasses and prescription swimming goggles
- Eye check-ups through medicare
- Hospital care, homes visits,office consultations.
So eg Bupa optical would have no gap options for a Bupa member but we have no gap options irrespective of the fund.
For major optical procedures, for example cataract or eye lens surgery, hospital cover from a private health fund is required.
These services are typically only included in high-level hospital cover policies, which attract higher premiums than basic policies.
Private health insurance composes hospital cover to avoid public hospital waiting lists and meet costs of private treatment as well as hospital services. Also extras cover is for the non-hospital everyday services like dental, optical and physiotherapy.
Levels of cover and yearly limits vary between funds and that some services only receive restricted cover, for example laser eye surgery on the front of the eye or inside the eye.
Australian private health funds will pay benefits for prescription glasses and/or contact lenses purchased from the vast majority of registered optical dispensers and eyewear stores, but not necessarily on line optical stores.
Benefit limits vary widely ranging from $100 up to over $600 on some premium policies. We can advise on your fund and policy rules.
Prescription sunglasses will be covered by the health fund in the vast majority of cases including transitions lenses that change with the amount of light.
However, non-prescription sunglasses are typically not included in extras cover.
Unlike other insurances, the premium is not affected by age, health status or other risk factors.
This is called community rating and offers protection from higher premiums on subsequent claims.
The Department of Health has the most up to date information and travel assistance sometimes can be availed from IPTAS.
MEDICARE EASYCLAIM AND HICAPS
Medicare rebates are not always allowed due to time frame restrictions often and were not often divulged due to privacy measures but possible eligibility should be able nowadays to be confirmed.
Medicare rebates for optometry services were frozen since 2015 until 2019 and often item numbers cannot be accessed.
If the Consumer Price Index had been applied to the Optometric Medicare Benefits Schedule since 1997, patients would be receiving over 50 per cent extra today in rebates for optometric consultations.
At one time, indexation of the MBS was negotiated between the Optometry profession and the Australian Government, but since the late 1990s a standardised indexation has been applied that has commonly been lower than the CPI and the other CPI of specific relevance to health.
From 1 July 2019 a 1.6 percent increase in medicare would apply to optometry items on the MBS, ending the long-standing freeze on rebates for these items,since November 2012.
A new way to pay for your eyecare. Buy now. Pay later. Zero interest. Up to 12 months to pay.
Openpay is a modern-day payment plan, enabling approriate care today, with payment over the selected period of time.
Who Can Use Openpay?
- Australian residents only
- 18 years +
- Have a valid ID, email, home address and mobile phone
- Have an active debit or credit card
Just like travel insurance or emergency ambulance cover it can pay to safeguard against refractive error or any vision loss from such conditions as diabetic retinopathy or eye problems eg cataracts that effect how the eye works by scattering light throughout the internal clear gel of the so called vitreous that fills the space between the lens and the retina of the eyeball, impacting the focus of light that enters the eye.
Consultations such as optical exams through medicare to examine the ciliary body for accommodation, aqueous humor regulation and maintenance of the lens zonules for the purpose of anchoring the lens in place may give rise to more fees and procedures such as a proposed artificial lens operation .
Medicare service does not currently cover digital retinal imaging or advanced optical coherence tomography (OCT) that gives sophisticated scans to detect and monitor the condition of the optic nerve and blood vessels for example nor prescription glasses nor everyday light sensitivity reducing sunglasses
You can claim to get help with medical costs in hospital,homes,or clinics. You may be able to use bulk billing. You can also find out how Medicare works with tax and private health insurance such as NIB offers,NIB health funds,Bupa health insurance etc from the Department of Human services
HEALTH FUNDS AND OPENPAY
Unlike the United States, Australia has Universal health coverage (UHC) with public and private systems serviced by health professionals.
Approx 57% of Australians also choose to have private cover
The government also provides a subsidy for private insurance costs to families using a sliding scale based on income to encourage uptake of private insurance.
All pay a 2% Medicare income tax levy. An additional levy of 1% is applied to high-income earners who choose not to take out private cover .
Pharmaceutical Benefits Scheme (PBS) caps the out of pocket cost of most medications for all Australians.
Prioritise your eyes. Pay later. Interest free. Manage & make payments in the app. Flexible payment plans
A clear solution.
Whether it’s a fresh look, new lenses or a necessary treatment, you can get it today with more time to pay.
Choose when you start and how often you pay.On the spot approval means no more waiting. A spectacular way to pay for your spectacles.
PUBLIC AND PRIVATE HOSPITAL COVER
The Medicare levy helps fund some of the costs of Australia’s public health system. The Medicare levy is (2% of your taxable income subject tosometimes reductions or exemptions)
The Medicare levy surcharge (MLS) is levied on Australian taxpayers who do not have an appropriate level of private patient hospital cover and earn above a certain income.
MLS is designed to encourage individuals to take out private patient hospital cover, and, to use the private hospital system to reduce demand on the public Medicare system eg cataract extraction
TAX DEDUCTABLE OPTICAL EXPENSES
Deductions for the cost of buying prescription glasses or contact lenses even if you wear them while working,is problematic as its a private expense relating to a personal medical condition.
However you may be able to claim a work related deduction for eg safety spectacles or goggles or equipment is required to alter the amount of light or protect the eyes both in front of and also behind the coloured part of the eyes.
eg if you are required to work outdoors and are exposed to the risk of eye damage from sunlight. This includes prescription sunglasses and anti-glare glasses.