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Medicare covers a wide range of medical procedures for Australians, but the biggest blind spot comes in the area of adult dental treatments.
In fact, private hospital cover plans don’t even include adult dental in their coverage options. You have to purchase extras cover to receive these services.
In this guide, we look at the current situation with Medicare and what you can expect from extras cover regarding dental services.
Medicare doesn’t cover much in the way of dental procedures. You will be able to receive emergency dental surgery in hospital if you need it, but there are only a small number of procedures that Medicare will cover. You will have to purchase private health insurance if you need additional coverage.
The exceptions to this rule are children and eligible adults.
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.
Medicare does not cover cosmetic or elective dental treatments, such as orthodontics. For these procedures, you will need to pay out of pocket or choose an extras policy that will apply.
The Australian government is aware of the dental problems facing low-income adults in Australia. Dental health is inherently linked with overall health, and failing oral hygiene can lead to a host of other medical issues down the line.
Multiple task forces and research groups have been created to combat the problem, and the government has provided some assistance to adults who require dental treatment.
As of January of 2017, the government provided the states and territories with $242.5 million to subsidise adult dental treatment. As of now, these treatments are only available to those with concession cards.
The level of treatment varies depending on the state, and there is a waiting period that depends on the severity of your condition.
Some fees apply in specific states, though others waive those fees for eligible adults.
Public dental treatments have been available for a while in Australia, but this influx of money should help improve the local systems. Unfortunately, those with lower a income are still far more likely to experience dental problems than those who can afford private healthcare.
Preventive checkups are the first line of defence against oral hygiene problems. With the average cost of preventative dental check-ups and cleanings around the $200 mark, you can expect to pay this out of your 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.
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 endodontic treatment as a part of their plans.
How much you can expect to pay for extras health insurance depends on the level of cover that you require. You might also face waiting periods when signing up for an extras plan.
Health funds can vary significantly regarding annual limits – which increases the potential for only being partially covered. This makes it crucial to check the finer details of what is included 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 covers cleanings, plaque removal, x-rays and minor fillings. The cost of these type of services varies, but the table below shows what you can expect to pay during your next visit:
The average waiting period for these services is around the two-month mark, though it can vary between health funds. You can expect your health fund to cover around 50-70% of the cost of these procedures.
Even the most basic Extras policies tend to include General Dental benefits. These plans will usually have low annual limits, though, and you’ll have to pay the rest out of pocket.
The more comprehensive Extras policies will be more generous regarding annual limits and will give you more of a cushion before you have to start paying for your services.
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 extraction, crowns, and dentures. The cost of these type of services varies, but the table below shows what you can expect to pay at your next visit:
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 braces or retainers and is popular with families.
It’s hard to estimate a figure for the cost of braces or retainers since the severity varies widely from case to case. In general, though, you can expect to pay anywhere from $1,000 to $8,000.
Endodontic treatment includes root canal surgery and treatment for exposed nerves. It is particularly necessary 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.
Your health fund might cover orthodontics and endodontics through their major dental benefits, but most have separate benefit categories for these. You can also expect to encounter a one-year waiting period for orthodontics and endodontic treatment.
Dental coverage alone often makes extras plans worth purchasing, but it isn’t all you’ll receive. Many basic extras policies include vision and physio, and higher-priced plans will cover major dental, massages, acupuncture, psychology, and other services.
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.
There are more than a few benefits to purchasing an extras policy, but for some Aussies, dental coverage is the leading factor. Make sure to compare extras policies before making a final decision.
There are three types of health insurance in Australia. They are:
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:
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.
Confused? Not sure if this applies to your situation? Phone us on 1300 163 402 for some free, no obligation advice.
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