Medicare,Bupa Optical,Health Funds,Openpay for your eyes

openpay payments

Medicare rebates are for the common eye examinations for private and public patient. Health fund rebates are for optical appliances. Health cover can include eye health treatment from kids to aged care.
No-Gap health fund options exist, as do 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) lists the Medicare services subsidised by the Australian government, including eye doctors and some allied health professions. Health funds such as Bupa Health Insurance Optical and Bupa Dental cover these specifically, but there is a large variety in the scope of items covered and the size of rebates between funds.

As part of government reforms, Health Insurance prices, terms and conditions changed on April 1st 2019. The Australian Government regulates the private health industry, although rules regarding membership vary between funds and, in some cases, will vary between states. At one time, the MBS index was negotiated between the Optometry profession and the Australian Government. Still, 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.


Offering you the modern Openpay solution. Ask us about downloading the Openpay mobile app to allow your optometry bills to be paid over 2-6 months without interest, or we can do the paperwork for you.

Method 1 if the customer can download the open pay app

Method 2 Where an open pay account is created manually using the ‘New Plan’ function.

Openpay is a modern-day payment plan, enabling appropriate care today, with payment over the selected period of time. Eligibility is for Australian residents only  18 years and over with valid ID, email, home address, mobile phone and active debit or credit card.

So buy now and pay later interest-free for certain services. Certain purchases are not discretionary but vital. Your correct spectacles and contact lenses enable a good vision for life so you can see more and do more. While Afterpay has a strict, pay in four, 8 week periods to pay back your purchases, Openpay allows more flexible repayment schedules and enables you to prioritise your eyes with pay later, interest-free payments managed in the app with flexible payment plans. Whether it’s a fresh look, new lenses or 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.

From 18 months and perhaps beyond, depending on your circumstances. You can also reschedule payments as you go to avoid late fees. No interest or fees if you pay on time new way to pay for your eye care.  Buy now. Pay later—zero interest with up to 12 months to pay.


claim optical extras

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 eyewear through the extras cover policies. These annual maximum limits reset each year 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.

no gap complete glasses

Certain waiting periods and other conditions can apply before benefits are payable. Prescription glasses and contact lenses for focusing the light that enters the eyes. 

  • Rebates on prescription sunglasses and prescription swimming goggles. Eye check-ups through medicare
  • Hospital care, homes visits, office consultations.
Bupa Optical glasses

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 online 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. The health fund will cover prescription sunglasses 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. How your eyes work after the medical intervention may affect your cover and benefits. We can check your individual situation, e.g. HCF members guidelines. 

So, e.g. 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 private treatment and hospital services costs. 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. 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

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. The schedule fee for eye focusing tests can vary if, for example, age-related macular degeneration is present, as assessing the fine detail of the blood vessels and the light-sensitive retina is required.


Medicare rebates for optometry services were frozen from 2015 until 2019, and often item numbers could not 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. From 1 July 2019, a 1.6 per cent increase in medicare would apply to optometry items on the MBS, ending the long-standing freeze on rebates for these items since November 2012.  

Unlike the United States, Australia has Universal health cover (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.


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 sometimes 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, e.g. cataract extraction.


Deductions for the cost of buying prescription glasses or contact lenses, even if you wear them while working, is problematic as it’s a private expense relating to a personal medical condition. However, you may be able to claim a work-related deduction. E.g. safety spectacles or goggles or equipment must alter the amount of light or protect the eyes both in front of and behind the coloured part of the eyes.  e.g. 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.

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