Navigating Medicare and Health Funds in Adelaide

At Complete Vision Care, we are committed to making quality eye care accessible and affordable. Understanding how Medicare and private health funds work can help maximise your benefits and reduce out-of-pocket expenses for eye care services.

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Maximising Your Benefits at Complete Vision Care

To make the most of your Medicare and private health fund benefits, consider the following tips:

Regular Eye Exams: Schedule regular eye exams to monitor your eye health and catch any issues early
Understand Your Coverage: Review your private health fund policy to understand what optical benefits you are entitled to
Combine Benefits: Use both Medicare and private health fund benefits where applicable
End-of-Year Benefits: Many private health funds reset their benefits at the end of the year. Make sure to use yours before they expire

Understanding Medicare

Medicare covers certain eye care services, primarily focusing on medical eye conditions. Here's what you need to know about Medicare coverage:

Eye Examinations

Medicare covers comprehensive eye examinations conducted by optometrists. These exams can include tests for vision acuity, prescription updates, and general eye health checks.
Regular eye exams are generally covered once every three years for people under 65 and once yearly for those 65 and older.
Medicare may cover more frequent eye exams if clinically necessary due to specific eye conditions or if referred by a healthcare provider.

Diagnosis and Treatment of Eye Conditions

Medicare covers consultations and diagnostic tests for eye conditions such as glaucoma, cataracts, diabetic retinopathy, macular degeneration, and other eye diseases.
Certain treatments, like laser therapy for glaucoma or diabetic retinopathy, may also be covered.

Not Covered by Medicare

Prescription Glasses and Contact Lenses: Medicare does not cover the cost of prescription glasses or contact lenses
Refractive Surgery (e.g., LASIK): Procedures primarily aimed at reducing dependence on glasses or contact lenses are not covered

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Private Health Funds

Private health funds offer additional coverage for a range of optometry services and products, often including those not covered by Medicare. The specifics of coverage can vary significantly between different health funds and levels of coverage.

Prescription Glasses and Contact Lenses

Many private health insurance plans include prescription glasses, frames, and lenses benefits
Coverage for contact lenses is also commonly included, often with annual or biennial limits

Additional Eye Examinations

While Medicare covers basic eye examinations, private health insurance can provide coverage for more frequent exams or additional diagnostic tests that Medicare might not cover.

Annual Limits

Each health fund and policy may have different annual limits and conditions. It's essential to check with your health fund to understand your entitlements and how often you can claim optical services.

Claiming Process

At Complete Vision Care, we offer on-the-spot claiming with HICAPS for most major health funds. This allows you to claim your rebate immediately, reducing your out-of-pocket expenses.