Maintaining good dental health is important for overall wellbeing, but we know that a trip to the dentist can create some anxiety in individuals, particularly around costs. However, there are a number of ways that individuals can receive some financial help with their dental treatments, including through private health extras and dental insurance. Interested in learning more? Let’s explore the types of dental cover available and what benefits they have.
Medicare vs private health
Before we get into the types of cover and options available for you, it is worthwhile covering the primary forms of health cover in Australia: Medicare and private health insurance.
Medicare is Australia’s taxpayer-funded healthcare insurance scheme, designed to make standard healthcare services accessible to Australian citizens and permanent residents. Medicare either fully or partially covers medical services by doctors and some specialists, as well as hospital treatments, prescription medications, and mental health care.
Medicare does not cover every health and medical service, including cosmetic surgery, ambulances, and most dental services. However, individuals can still receive some cover on these other services through private health insurance. Private health is made of two major types: hospital cover and general treatment cover. These types work in tandem with Medicare but provide more choice in hospitals and doctors for patients, and often reduce wait times.
General treatment cover — often referred to as extras cover — allows individuals to claim for a range of services outside of the hospital, including dental.
Does Medicare cover dental?
Medicare unfortunately does not cover dental procedures for adults, but it does provide some cover for children’s dental through the Child Dental Benefits Schedule (CDBS). The government program is designed to ensure children grow up with positive oral health habits and the knowledge of how to keep their teeth healthy. The CDBS allows families to access up to $1052 over 2 calendar years for each eligible child under the age of 17. CDBS covers basic dental services including check-ups, x-rays, cleans, fillings and root canals. It does not cover orthodontic or cosmetic dental treatments.
To be eligible, either a parent/guardian or the child must receive an eligible payment from the government.
Dental insurance
As we’ve noted, dental services are typically covered under the extras in your insurance policies. However, individuals can also take out stand alone dental insurance policies, solely focused on providing comprehensive cover for dental procedures and treatment. Dental insurance can cover standard services as well as major treatments and orthodontics, depending on the level of cover you are receiving.
What does dental insurance cover?
The services you can claim on your dental insurance depend on the type of policy you have, and how extensive the cover is. Dental insurance or private health extras typically help to cover the cost of general dental treatments, but can be extended to cover more extensive procedures and treatments.
Preventative and general care
General extras and dental cover helps patients to pay for basic treatments including scale and cleans, oral exams, and fillings. It can also help to cover the cost of dental x-rays, which are important for ongoing dental care and monitoring of issues.
Major treatments
Patients with major dental cover can receive help paying for complex treatments including wisdom teeth removal, general tooth extraction, dental implants, crowns and bridges, as well as dentures. Having cover for these can provide great peace of mind for individuals as they get older and may experience some natural dental issues. Good oral care and daily dental health habits are always recommended, but cover can make it less of a burden to manage unexpected dental needs.
Specialist Services
Orthodontic treatments are not always covered by private health insurance. However, they can often be included for individuals with a higher level of extras cover, helping to cover a portion of the cost for different treatment courses. It is always worth checking very thoroughly which orthodontic items are covered before committing to a policy.
Other treatments like periodontics and endodontics are also only covered by some policies. These treatments cover gum disease treatment and root canal therapy, which can become more prevalent with age. Assess any policy closely to identify whether cover for these treatments is included.
Things to consider
Outside of the types of treatments covered, there are a number of important things to keep in mind when assessing an insurance policy and deciding to make a claim with it.
Claim limits
Many extras and dental-specific insurance policies impose an annual limit on the benefits able to be claimed for dental treatments. Each type of cover and insurance provider will offer a different level of cover, but individuals can only access a rebate while they are under that limit. Once they have claimed above that limit, they will have to pay for any further dental treatments completely out of pocket.
Gap payments
In many cases, your insurance will not cover the entire cost of a dental treatment, but will be able to cover a partial cost. The extra that you have to cover on top of that is called the ‘gap payment’. Before booking any treatment, ensure you ask about any gap payments you may incur between your benefit limit and the full cost of treatment.
Preferred providers
Many insurers have a network of dental providers that they recommend individuals under their cover use. While this is not typically mandatory, booking with these providers can allow you to access a higher benefit limit or a reduced gap payment. Check with your insurer if they have any preferred providers before booking any treatments.
However, insurance companies often do not tell you that typically, the fee they pay the dentist to provide treatment is so low that a dental surgery’s costs may not be covered. As a result, these preferred providers often hire staff who are inexperienced or newly graduated , or have appointment times reduced so that they can book more patients into the day in order to turn a profit. There have also been incidents of other cost cutting measures like using inferior products or reusing items that are disposable.
