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Medicare and Dental Cover

Jonathan June 4th, 2015 0 comments

Medicare provides hospital coverage and pays up to the Medicare Benefits Schedule (MBS) for covered services. Dental services for adults are not covered by Medicare. This means if you need any type of dental treatment, you will either need a private extras policy or will need to pay out of pocket for dental services.  You should consider the purchase of an extras policy before you need costly dental care because getting a root canal, wisdom tooth removed, or other dental service can be very expensive if you do not have private insurance coverage.

What Does Medicare Cover for Dental Services?

Medicare does not provide coverage for dental services for adults.  In the past, there was some support for Medicare patients who needed dental care. For example, the Chronic Disease Dental Schedule provided up to $4,250 over two years for people with a chronic dental problem whose oral health issues were impacting their general health.

Unfortunately, the Chronic Disease Dental Scheme has been closed since 1 December 2012. Since that time, no Medicare benefits are payable for any dental services provided to adults even with chronic conditions.  The Medicare Teen Dental Plan has also been discontinued as of 1 January 2014.

Today, Medicare provides limited coverage ONLY for children under the Child Dental Benefits Schedule. You will have to pay out-of-pocket for all dental services unless the services are covered by the Child Dental Benefits Schedule.

What is the Child Dental Benefits Schedule?

The Child Dental Benefits Schedule provides coverage for up to $1,000 in dental services per child over the course of two consecutive calendar years. If you do not use any of the $1,000 in covered treatment during the fist year of eligibility, the full $1,000 may be claimed during the second year as long as you are still eligible for coverage. No balances are carried forward after the end of the second year.  This means any portion of the $1,000 not claimed during a two-year eligibility period is lost.

Who is Eligible for Medicare Dental Coverage?

Only children and teenagers are eligible to receive any dental services paid for by Medicare. The Child Dental Benefits Schedule provides coverage for children who are between the ages of two and 17 on at least one day during the calendar year.  The child must be eligible for Medicare.

Certain other criteria must also be met. For example either the child, the parent, the carer, or the guardian must receive certain other benefits or credits such as financial assistance from the Military Rehabilitation and Compensation Act Education and Training Scheme; or Family Tax benefit Part A.    The website of the Department of Human Services provides full details on the types of public benefits or tax credits that a child, parent, guardian, or carer must be receiving in order for a child or teen to be covered under Medicare?s Child Dental Benefits Schedule.

What Types of Dental Services Does Medicare Coverage?

For children and teens who qualify for coverage under the Child Dental Benefits Schedule, Medicare will pay for examinations, oral x-rays, teeth cleaning, fillings of cavities, sealing fissures, extractions and root canals.

Medicare does not provide coverage for any dental services that are provided in a hospital. Medicare also does not cover either orthodontic or cosmetic dental work.

Do Dental Services Count Toward the Medicare Safety Net?

Services provided under the Child Dental Benefits Schedule do not count towards either the Medicare Safety Net or the Extended Medicare Safety Net Thresholds.

How Can You Get Dental Services Covered by Medicare?

If you believe your child is eligible for dental services covered by Medicare, you can contact the Medicare general enquiries line or go to myGov to confirm your child?s eligibility and to check the remaining balance amount.  Once you have confirmed that you have coverage, you can make an appointment with a public or private dental provider and let the provider know you are eligible for the Medicare Child Dental Benefits Schedule.

When you visit a provider, the dental care professional will discuss coverage, services, and any costs associated with treatment. Once you are informed of what your costs will be, you must sign a consent form. The dental provider will perform the agreed-upon services and you will be charged or the dentist will bulk bill. If you are charged, you must pay the bill and then claim the benefit from Medicare.

What Other Options are There for Dental Care?

Medicare provides such limited dental care coverage that you will essentially be paying for almost all services out of pocket. You can get more affordable dental services and control your costs by purchasing private dental insurance.  This dental guide explains dental coverage, private dental policies, and how to get the dental services you need.

The lovely Aimie from Aim High Training and Development will be back for a First Aid for Babies and Children workshop on Friday 1st July, 10 am to 12 noon.

Disclaimer: The above information is correct and current at the time of publication.

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