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What is optical health insurance?
Optical health insurance refers to private health cover that helps pay for vision-related services and products, such as prescription eyewear and eye tests. In Australia, optical cover is typically included as part of an Extras policy – not Hospital cover – and is designed to reduce out-of-pocket costs for routine eye care and corrective lenses.
It’s a popular choice for individuals and families who wear glasses or contact lenses, or who want to manage the cost of regular eye check-ups outside of Medicare. Depending on the level of Extras cover you choose, you may be able to claim for partial or full rebates on a range of optical services.
What optical services are covered under Extras?
Prescription glasses
Most Extras products provide a benefit towards the cost of prescription glasses. This includes both single-vision and multifocal lenses, as well as frames. Some funds partner with preferred optical providers, allowing you to claim 100% of the cost up to your annual limit.
Contact lenses
If you prefer contacts over glasses, many Extras policies include rebates on prescription contact lenses. This applies whether you buy them in-store or online, as long as you use a registered provider and the lenses are prescribed by an optometrist.
Eye tests
While Medicare generally covers the cost of standard eye tests with optometrists, some Extras policies may include coverage for additional or more frequent tests. This may be of value if you’re monitoring a vision condition or need enhanced screenings.
Prescription sunglasses
Certain policies also cover prescription sunglasses, which combine UV protection with vision correction. These are often subject to the same annual optical limits as regular glasses or contacts.
Keep in mind that each insurer sets its own annual limits for optical. Depending on your level of Extras cover, you may have a standalone annual limit for optical services (e.g. $200), or optical may be grouped under a combined limit with other services like remedial massage or physiotherapy.
How much does optical health insurance cost?
The monthly cost of optical health insurance typically starts from around $20, but can exceed $250 depending on the Extras policy. Factors that influence the price include the level of cover – from basic to comprehensive – and whether you combine Extras with a Hospital policy.
Policies that offer higher annual limits for optical or “no-gap” deals with preferred providers generally come at a higher cost.
If you regularly buy new glasses or contact lenses, a higher-tier Extras policy may offer better long-term value. On the other hand, if you only need basic optical support every few years, a basic no-frills policy may be enough.
Chris Whitelaw, General Manager - Health Insurance at Money.com.au
“Most insurers partner with preferred optical providers through negotiated pricing and special agreements. Choosing these providers can significantly lower your out-of-pocket costs. For example, if an optometrist charges $250 for frames and lenses, you might only get a $150 rebate outside the network, whereas using a preferred provider could mean minimal or no out-of-pocket expense – plus access to exclusive offers, such as discounts or two designer pairs of frames for $250.”
Chris Whitelaw, General Manager - Health Insurance at Money.com.au
Why take out optical cover?
Taking out optical health insurance can help reduce the cost of maintaining your vision and accessing regular eye care. While Medicare covers standard eye tests, it doesn’t cover glasses, contact lenses or prescription sunglasses – which is where Extras cover with optical benefits can make a real difference.
If you wear glasses or contact lenses, optical cover can help you save hundreds of dollars each year through annual rebates. It’s also a practical option for families with children who may need regular vision checks or new eyewear as they grow.
According to a Money.com.au survey, 27% of respondents said they chose their Extras cover specifically to access optical products like glasses and contact lenses, while 15% said they’d invest more in optical and eye care if they could afford it.
The demand is reflected in industry figures too – APRA reported that optical was the second largest Extras category by benefits paid, totalling $274.9 million in the March 2024 quarter. The average benefit per optical service was $83.75, up 3.9% from the previous quarter, showing that claim values are rising alongside consumer needs.
While optical cover under an Extras policy helps with out-of-hospital costs like glasses and contact lenses, it does not cover hospital treatments for serious eye conditions. Procedures such as cataract surgery, treatment for glaucoma, or retinal repairs fall under Hospital cover, which may only be included in higher-tier policies like Silver Plus or Gold. To be covered for these inpatient services, you’ll need a Hospital policy that specifically includes eye-related procedures.
What to look for in optical health insurance
Here are some key points to consider when choosing the best health insurance for optical:
1
Annual limits for optical cover
Check the annual limit your policy offers specifically for optical services. Some policies provide a separate limit (e.g. $200 per year just for glasses and contacts), while others group optical within a combined Extras limit shared with other services like dental cover or physiotherapy. If you regularly purchase eyewear, a higher dedicated optical limit can save you more.
2
Waiting periods
Most health funds require a waiting period before you can claim optical benefits, typically 2-6 months. Be aware of this when switching policies or signing up, especially if you need new glasses or contacts soon. Some funds may waive waiting periods if you switch directly from another policy and haven’t claimed any optical benefits in the past two or six months.
3
Choice of providers and no-gap deals
Find out which optical providers are included in the insurer’s network. Many health funds partner with major optical retailers like Specsavers or OPSM, offering no-gap or discounted eyewear deals. Using preferred providers can maximise your rebate and reduce out-of-pocket expenses.
4
Coverage for different optical products
Confirm whether the policy covers both prescription glasses and contact lenses, including specialty lenses like multifocals or coloured contacts. Some policies may also cover prescription sunglasses or repairs, so check the fine print if these matter to you.
5
Combining optical cover with other Extras
Extras policies often bundle optical cover with other popular services such as dental, physiotherapy or natural therapies. If you want broader wellness cover, consider policies that balance optical benefits with other services you use frequently, to get better overall value.
