Is it possible to get no-gap optical?
Other than eye exams and checkups with an optometrist, which can often be bulk-billed, optical services are not covered by Medicare. Prescription lenses, frames and contact lenses are not covered. If you don’t have extras cover, you will have to pay for these out of your own pocket.
Compare optical extras with no gap
Below are a few Finder partners that cover Optical in their extras policies. We've displayed the yearly limit. They also include other benefits such as dental or physio...using the range of treatments included is a great way to get value for money.
|Fund||Policy||Included treatments||Waiting Period||Limit||Price||Apply|
||2 months||$100||$16.25||Go to Site|
||6 months||$250||$30.26||Go to Site|
||6 months||$200||$34.50||Go to Site|
*Price based on a single female living in NSW, always check for combined limits
Optical services and health insurance
Extras cover is available in several levels (basic, medium and comprehensive) and generally covers ancillary services such as optical, dental and physio up to set annual benefit limits.
What is the medical gap and how do I avoid it?
If a doctor charges a higher fee than the Medicare Benefit Schedule (MBS) fee for a service, the medical gap is the difference between the MBS fee and the doctor’s fee. This amount will have to be paid either by your health fund or by you.
In the case of optical services that are not listed on the MBS, the medical gap is the gap between what an optometrist charges for lenses and frames and what your private health extras cover will pay towards them.
To avoid having to pay any medical gap, you need to be with a health fund that has a no-gap scheme. A no-gap optical scheme is one where a health fund agrees to cover the medical gap if members go to a preferred optometrist or an optical dispenser with which the health fund has an arrangement. These practices charge capped prices that have been agreed upon with the health fund for a select range of lenses and frames.
Which health funds have a no-gap optical scheme?
Here are Finder's partner health funds that offer a no-gap optical option:
|Fund||What’s covered?||More info
|ahm offers 100% back up to your annual limit on the cost of prescription glasses, frames, lenses, repairs, and contact lenses.||More info|
|HCF offers a range of fully covered services through HCF Eyecare Centres, Dresden, or Specsavers on a range of standardd prescription glasses and one free digital retinal imaging with your eye test per calendar year.||More info|
|You can claim 100% of your annual limit on prescription glasses, contact lenses or sunglasses from any optical provider in Australia with HIF.||More info|
|Transport Health offers members 100% back on a selection of single vision, bifocal and multifocal glasses from several ranges at Specsavers (depending on your level of cover).||More info|
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