Short answer: Yes, but only on one retail policy, and only up to a set amount. Medibank pays towards laser eye surgery on Gold Ultra Health Cover. The government’s policy statement for Gold Ultra lists laser eye surgery at 100% back up to a $3,500 lifetime limit, with a 36-month waiting period, where no Medicare benefit is payable (privatehealth.gov.au). Medibank’s glossary says laser eye surgery is only included under Gold Ultra (Medibank). Check your own policy with Medibank before you book.
This guide explains what Medibank’s own documents say, what the $3,500 means in practice for laser eye surgery at Focus Vision in Brisbane, and how to check your cover. It is general information, not insurance or financial advice, and Medibank changes its products from time to time.
Which Medibank policy pays for laser eye surgery?
Gold Ultra Health Cover is a package that combines Medibank’s Gold hospital cover with extras. Medibank describes it as including “exclusive Ultra benefits, such as laser eye surgery”, which can include LASIK, LASEK and PRK, with benefits payable only where no Medicare rebate applies (Medibank).
Medibank’s glossary is explicit that laser eye surgery is only included under Gold Ultra, and that its major eye surgery hospital category does not include laser eye surgery done to correct vision instead of wearing glasses or contact lenses (Medibank).
Employer policies. Some Medibank extras policies offered through employers also list a laser eye surgery benefit, with a smaller annual limit. For example, the statements for Extras 70 and Extras 85 list $500 and $750 annual limits, each with a 36-month wait (privatehealth.gov.au; privatehealth.gov.au). Extras 90 Boost lists $750 a year and is available to employees of companies with an agreement with Medibank (Medibank). If you have cover through work, check your own statement.
What Gold Ultra pays, and the conditions
| What Medibank’s documents say | |
|---|---|
| Benefit | 100% back, up to the limit |
| Limit | $3,500 per person (described as a lifetime limit) |
| Waiting period | 36 months |
| Condition | Only where no Medicare benefit is payable |
| Procedures named | LASIK, LASEK and PRK |
Sources: the Gold Ultra Private Health Information Statement (privatehealth.gov.au) and Medibank’s Gold Ultra page (Medibank).
Lifetime or annual? The government statement describes the $3,500 as a lifetime limit, and Medibank’s glossary refers to lifetime limits too. Medibank’s product page describes it as an annual limit per person. Either way, it is $3,500 per person rather than per eye. Ask Medibank which applies to your policy and how much you have left.
Which procedures count. Medibank names LASIK, LASEK and PRK. TransPRK is a form of PRK. CLEAR lenticule extraction is not named, so quote the exact procedure your surgeon recommends and ask Medibank to confirm it in writing.
ICL and lens exchange. Medibank’s laser eye wording does not mention implantable contact lenses or refractive lens exchange. Don’t assume either is covered by this benefit without written confirmation.
What the $3,500 means for your out-of-pocket cost
Because the limit is per person, the benefit is the same whether you treat one eye or two. As a worked example with Focus Vision’s all-inclusive prices per eye (our costs page), and assuming Medibank approves the full $3,500:
| Procedure (both eyes) | Focus Vision price | Less $3,500 benefit | You pay |
|---|---|---|---|
| TransPRK | $7,000 | −$3,500 | $3,500 |
| LASIK or Ray Tracing LASIK | $8,500 | −$3,500 | $5,000 |
Prescribed medications and eye drops are bought separately and are not included in these figures. Your actual benefit depends on your policy, how much of your limit you’ve used, and Medibank’s assessment of your claim. Focus Vision works with Medibank members, and our team can give Medibank the details it needs. Ask Medibank to confirm your surgeon and procedure before you book.
What if you’re on another Medibank policy?
Most Medibank members hold Silver, Bronze or Basic hospital cover with a standard extras policy, and those don’t include laser eye surgery. Elective laser eye surgery is then paid privately. Your cover can still help with your eyes in other ways:
- Cataract surgery. Cataracts is a clinical category that every Gold hospital policy must include; it is optional on Silver, Bronze and Basic (privatehealth.gov.au). Medibank notes that many Silver hospital covers include it (Medibank), and that for a claim your cover must list Cataracts as an included or restricted service (Medibank). Cataract surgery is also Medicare-eligible.
- Optical extras. Benefits for glasses and contact lenses don’t apply to laser eye surgery, but they are useful when you compare the long-run cost of glasses and contacts with surgery.
Medicare and laser eye surgery
Medicare does not pay for laser eye surgery to correct short-sightedness, long-sightedness or astigmatism, because it is treated as elective (healthdirect). That is why Medibank’s benefit is paid “where no Medicare benefit is payable”. ICL surgery for refractive purposes is not covered by Medicare either. Cataract surgery has a Medicare item (MBS item 42702), and clinically indicated pterygium surgery is also Medicare-eligible.
Should you upgrade to Gold Ultra for laser eye surgery?
We can’t give financial advice, but the sums are simple:
- Ask Medibank for the Gold Ultra premium for your situation, and the difference from what you pay now.
- Multiply the difference by at least three years, because that is how long you wait before you can claim.
- Compare the total with the most Medibank would pay: $3,500 per person.
- Weigh the other benefits of Gold Ultra (Gold hospital cover and its extras) and whether you would keep it anyway.
If the extra premium over three years is close to $3,500, upgrading only for laser eye surgery may not save you money. Your eyes also need to be suitable at the end of the wait, which is why an assessment comes first.
How to check your own Medibank cover
- Find your policy statement. Every Australian policy has a Private Health Information Statement on privatehealth.gov.au. Search for your exact policy name and state, and look for a “Laser eye surgery” line.
- Log in to My Medibank or call Medibank with your membership number. Ask:
- Does my policy include laser eye surgery, and how much will you pay for [procedure name]?
- Is the limit lifetime or annual, and how much have I used?
- When did my 36-month waiting period start, and when does it finish?
- Is my surgeon recognised for this benefit?
- Get the answer in writing before you book surgery.
Our team checks your entitlements as part of your free optometrist assessment.
Focus Vision prices
All-inclusive prices per eye at Focus Vision: TransPRK from $3,500; LASIK and Ray Tracing LASIK from $4,250; CLEAR from $4,250; ICL from $7,000 including the anaesthetist; refractive lens exchange from $6,000 including the anaesthetist. They cover pre-operative assessments, the procedure and a year of follow-up appointments, with no surcharge for higher prescriptions. Prescribed medications and eye drops are extra. Interest-free payment plans over 24 months start from $34 a week, and enhancements are free for two years under our enhancement policy. Full details are on our costs page.
With Bupa instead? See Does Bupa cover laser eye surgery?
To find out whether you’re suitable and what your cover will pay, book a free optometrist assessment or call (07) 3239 5005.
This article is general information only and is not insurance, financial or medical advice. Health insurance products change; always confirm your cover with Medibank using your membership number.
References
- Medibank Private Limited. Gold Ultra Health Cover: Private Health Information Statement. privatehealth.gov.au. privatehealth.gov.au/dynamic/Download/MBP/J20/NCDI10
- Medibank. Gold Ultra Health Cover. medibank.com.au/health-insurance/cover/gold-ultra-health
- Medibank. Health insurance glossary. medibank.com.au/health-insurance/understanding-health-insurance/glossary
- Medibank Private Limited. Extras 70: Private Health Information Statement. privatehealth.gov.au. privatehealth.gov.au/dynamic/Download/MBP/I52/VCWW2Y
- Medibank Private Limited. Extras 85: Private Health Information Statement. privatehealth.gov.au. privatehealth.gov.au/dynamic/Download/MBP/I51/NCSW10
- Medibank. Extras 90 Boost cover summary. medibank.com.au
- Australian Government. Private health insurance product tiers. privatehealth.gov.au. privatehealth.gov.au/health_insurance/howitworks/producttiers.htm
- Medibank. Gold vs Silver hospital cover. medibank.com.au/health-insurance/understanding-health-insurance/gold-vs-silver-hospital-cover
- Medibank. Cataract surgery costs. medibank.com.au/health-support/hospital-assist/costs/cataracts
- healthdirect Australia. Laser eye surgery. healthdirect.gov.au/laser-eye-surgery
- Australian Government Department of Health. Medicare Benefits Schedule, Item 42702. MBS Online. www9.health.gov.au