Private Health Insurance and Dental
In Australia, we’re lucky enough to have a fantastic public health care system in the form of Medicare, through which many services are free or subsidised. However, despite the fact that good oral health is crucial for overall wellbeing, Medicare does not offer much support for dental services. This means that ancillary/Extras coveris a must have for taking good care of your teeth. In this guide, we look at the current situation with Medicare and what you can expect from extras cover in terms of dental services.
What Medicare Covers
There is little support available for dental services on Medicare. Some surgical procedures carried out by approved dentists will be covered but most examinations and treatments are not subsidised through Medicare and will require private health insurance.
Some support is available for children, notably in the form of The Child Dental Benefits Scheme (CDBS). This covers basic dental services for children aged 2-17 years – provided that they are eligible for Medicare and that a parent, guardian or carer receives certain government payments for at least one day of the calendar year. This includes Family Tax Benefit Part A.
The CDBS covers examinations, x-rays, teeth cleaning, fillings, root canal work and extractions, although there are often restrictions associated with claiming on these. Support is capped at $1,000 over two consecutive calendar years.
Because there is only limited support via Medicare for kids dental, parents can purchase Extras cover that includes dental services to help cover other costs. Most basic extras policies include general dental services to some degree, although it is common for annual limits to be on the low side. Orthodontic and cosmetic dental work is not covered through Medicare at all and a relatively comprehensive level of extras cover is definitely needed.
Private Health Insurance and Dental Services
To keep your teeth healthy, you should look to visit the dentist every six months. With the average cost of preventative dental check-ups costing around the $200 mark, you can expect to pay this out of your own pocket each time if you don’t have health insurance that includes dental services. Add in the potential for fillings, crowns and other dental treatments and you could be looking at sizeable out-of-pocket costs. Fortunately, Ancillary/Extras cover will protect against this.
There are two main types of dental cover available on ancillary/extras policies: General Dental and Major Dental. Some health funds also offer orthodontic and/or endodontic treatment as as part of their cover.
How much you can expect to pay for Extras health insurance depends on the level of cover that you want to have. Each health fund can set their own waiting time for Extras and may waive these as sign up incentives for new members.
Health funds can also vary significantly in terms of annual limits – which increases the potential for only being partially covered. This makes it crucial to check the finer details of what is covered to minimise or avoid out-of-pocket costs and to compare your options by shopping around.
General Dental is included on most Extras policies and includes cleanings, plaque removal, x rays and minor fillings. The average cost of these type of services varies according to state but here’s what you could expect to pay at your next visit:
- Scale and clean- An average of just over $104
- Plaque removal – An average of just over $57
- Fluoride treatment – An average of just over $32
- X rays – The average check up involves 1-2 x rays, especially if members have not had them for a couple of years, at an average cost of just over $41 each
Generally speaking, the average wait time for these services is around the two month mark, although it can vary between health funds.
Even the most basic Extras policies tend to include General Dental benefits, although these will usually have low annual limits with out-of-pocket costs if members need to have dental services that exceed the threshold. The more comprehensive Extras policies will be more generous in terms of annual limits and there will be less potential for out-of-pocket costs.
Major Dental is not available on basic Extras options and will require a more comprehensive choice of policy. This type of dental cover goes way beyond General Dental and includes more extensive work such as wisdom teeth removal, crowns, dentures and orthodontics. The cost for these type of services varies according to state but here’s what you could expect to pay in recent years:
- Wisdom teeth removal – The average cost of removing a tooth was around the $200 mark. For more complex cases, this rose to anything up to $500 per extraction.
- Crowns – The average cost was just over the $1,440 mark (for a full crown)
- Bridges – With two full crowns (veneered) and a replacement tooth, the average cost was over $3000
Generally speaking, the average wait time for these type of services is around the twelve month mark so it is something that needs to be thought about before major dental work is definitely needed.
Orthodontic treatment is designed to treat misalignment issues with teeth, jaws and bites. It is commonly used to correct crooked teeth via fixed braces or removal retainers and is therefore often popular with families.
- The costs of orthodontic treatment involving upper and lower braces varies from $4500 to $8000 or even more in severe cases. This figure is cheaper if braces are only needed on either the upper or lower teeth.
There is typically a twelve month waiting period attached to orthodontics. Basic Extras policies rarely include orthodontic benefits or have low annual limits that make out-of-pocket costs inevitable. A more comprehensive Extras policy is therefore needed to ensure adequate cover.
Endodontic treatment includes root canal surgery and treatment for exposed nerves. It is particularly recommended for those with tooth decay or damage that could otherwise result in infection.
- The average cost of root canal work has been hundreds and even thousands of dollars in recent years.
There is generally a twelve month wait on endodontic services and it is sometimes included as part of Major Dental cover.
What You Can Expect to Get Back
Some health funds offer “No Gap” dental services in which checkups and preventative hygiene treatments are essentially free. This can go a long way towards reducing out-of-pocket costs but it’s not offered by everyone. It may also involve using a dentist who participates in the health fund’s “No Gap” scheme, and members may not be able to use a practitioner of their choice.
A number of health funds will have their own Dental Centres, which will often mean lower costs for their members. They may still be some out-of-pocket costs that need to be met but generally, using one of these clinics will reduce them. In most cases, these Dental Centres are also open to non-members but the biggest benefits are only available to members.
Some health funds offer a certain percentage back on Extras policies – up to the specified annual limit. For example, members may get sixty per cent back on Extras services.
Frequently Asked Questions About Health Insurance
There are three types of health insurance in Australia. They are:
- Hospital Cover
- Extras Cover (also known as general or ancillary cover)
- Ambulance Cover
Hospital cover can ensure any unexpected surgeries, treatments or hospital stays you may require will be covered. With appropriate cover you will have the flexibility to choose your own doctor and the option of receiving treatment in a private hospital. Most hospital covers allow you to stay in a private room. One other perk is skipping the public hospital systems’ waiting list, which can be lengthy for non emergency treatment.
Extras cover pays benefits for a a range of services, often including treatments and procedures related to the fullowing:
- Dental/oral health
- Glasses and contact lenses
- Remedial massage
- Hearing aids
- Travel vaccinations
Ambulance cover, as the name suggests, will cover you should you require emergency ambulance transport. In an emergency, there is enough to worry about. Having the expenses covered for provides security and peace of mind. Many hospital covers include emergency ambulance transport If yours doesn’t, you will need to shop for this separately.
Life is unpredictable. You never know when you might need cover. No matter what life stage you’re in, there’s a policy out there for everyone. You can select as much or as little cover as you want, depending on your health needs and requirements. It’s a small price to pay for the peace of mind health cover provides.
There is no one answer here. Costs vary across providers and policy types. Just because a policy is cheap, that does not mean it is ‘value for money’ and vise versa. Make sure you check what’s included and excluded in a policy before signing up, as you want to purchase a policy that best fits your specific needs.
Premium: A premium is the price you pay for your insurance policy (it may be paid annually or on an ongoing basis).
Policy: An insurance plan. In other words, it is the type of insurance you choose to select.
Policy Holder: The owner, or ‘holder’ of a policy.
Claim: In the event that you require treatment for a service covered by your policy, you can lodge a claim for reimbursement of all or part of the cost of that treatment.. These days, most claims are submitted electronically by the health care provider (dentist, physio etc)
Lifetime Health Cover: Lifetime Health Cover was put in place to encourage young Australians to seek out and maintain ownership of private health insurance early in their lives. If you do not take out a policy before you turn 31, extra charges will be applied should you take out a policy at a later time.
This means you will pay a 2% loading on top of your premium for every year that passes after you turn 30. For example, if you take out a policy for the first time at age 32, you will be charged 4% of your premium as an extra, then at age 40, 20% and so on, up to a maximum loading of 70%.
The loading is payable for 10 consecutive years of cover - after which it is removed and you premiums will be reduced.
Pharmaceutical Benefits Scheme (PBS): Medicare offers assistance for Australians with many of their their prescribed medication costs through the PBS. This assistance is in the form of subsidies towards the cost of many medications. You can check if your prescribed medication is on the list of subsidised items here.
Medicare Levy Surcharge: The Medicare Levy Surcharge is an additional charge (tax) applied to single Australian taxpayers who earn over the income threshold of $90,000 per year, or families/couples who earn over $180,000 per year. This surcharge is only applied to those who choose not to have a private health insurance policy.
The surcharge is designed to reduce pressure on the public health system by encouraging those with higher incomes to invest in private health cover.
Private Health Insurance Rebate: The government’s Private Health Insurance rebate lowers premiums for most Australians with private health insurance Older Australians may enjoy an even higher rebate. Our calculator can help you estimate the Government health insurance rebate you may receive.
Disclaimer: The above information is correct and current at the time of publication
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