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Last Updated on 17 November 2018

Should Kids Dental Be Included on Medicare? (Part 2)

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 seen as being vital for overall wellbeing, Medicare does not currently offer much support in terms of dental services for children.

How Much It Costs

  • In Australia, the fee for 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.

The Current Situation

The Child Dental Benefits Scheme (CDBS)  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. NB: This is less than a quarter of the typical cost of braces.

Because there is only limited support via Medicare for kids dental, parents need to purchase extras cover that includes dental services to ensure that their children’s teeth are well looked after. Most basic extras policies include general dental services to some degree, although it is common for annual limits to be on the low side. To be covered for major dental and orthodontic work, broader extras cover is needed. Orthodontic and cosmetic dental work is not covered through Medicare at all and a relatively comprehensive level of extras cover is definitely needed.

How Australia Compares to Other Countries

The UK situation

In the UK, the National Health Service (NHS) covers dental services for children. There is no charge for dental treatment for those aged under 18, and this includes orthodontic work if the alignment and/or arrangement of the teeth will definitely cause problems if uncorrected. Orthodontic work that is predominantly or purely cosmetic will not be covered on the NHS and will need to be paid for.

The US situation

US states are obliged to provide dental benefits to children eligible for Medicaid and the Children’s Health Insurance Program (CHIP). The Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit offers a broad range of preventative dental health services for children aged under 21 who are enrolled in Medicaid – and this includes some dental services. Orthodontic is not subsidised and must be paid for privately.

Should There Be More Support for Kids-Related Dental Services on Medicare?

We recently asked various Australians mums for their views on whether they feel that Medicare currently offers adequate support for kids dental services. This post was a big success – so much so that we’ve decided to put together a second part. Here’s what more mums (and the odd dad!) had to say!

Simon at Fast Lane Dad

I love my kids and as they are boys they are happy to try and get out of cleaning their teeth if at all possible as it gets in the way of a good play!

Coming from the UK, I was really surprised to find that here in Australia, dental care for children has to be paid for as it is free back in the UK.

I hear that dental vans visit schools in Queensland, and I think that’s a great idea. I’m sure parents would be happy to book time during the day to visit the dentist – I know I would!

Whatever the incentive or initiative, visiting the dentist really should be free for our kids as it can be a drain on the family budget.

We’ve always had private health insurance and accessed their Dental Clinics. Now we live in a rural area and access the University Dental clinic -only for fillings and checkups. Both my sons (aged 8) will need orthodontic services to correct their jaw alignment and to adjust their teeth / jaw. Orthodontics has limited coverage even with Top Health cover.

In an ideal world, fillings and orthodontics etc should all be included on the Medicare schedule to provide disadvantaged families with a measure of financial relief. Whether it is means tested, subsidized ($1000) or even as a tax rebate (the Govt. has changed eligibility for net medical expenses tax offset; restricting who can claim and what medical expenses can be claimed).

Kids’ teeth are the last thing that people consider on a budget. Early intervention and education will help to reduce preventable medical and social issues stemming from dental disease. Good teeth are essential for confidence, speech and overall health. As a paediatric nurse 15yrs ago, I saw many children under 5 with all of their teeth being removed under general anaesthetic.

Teeth are so important and keeping them healthy isn’t just about appearances.  I think that all kids, regardless of how much their parents earn, should be able to access dental care because tooth pain and the resulting infections can be a horrible experience for a child.

I also think that the free dental needs to be about preserving teeth rather than taking the quickest and often most painful route which is what the current adult system is.  Having a positive dental experience when young can be the difference between a child learning to take care of their teeth and avoiding the dentist once they are old enough to make the decision themselves.

Fee Dixon at Oh Gorgeous

As someone who doesn’t love her teeth, I definitely wish Medicare included dental.   Not for my sake but for my kids, so they are able to gain access to the dental care that I didn’t have.

Often the cost of dental care is forced to the bottom of a family’s budget. This is not because we don’t want to provide dental care for our kids, but because it costs so much! The cost of living is increasing year by year and costs much more than ever before.

As a society we are also consuming foods and drinks that are not beneficial to our dental, or overall health too. Even when we think we are making the right choices, you find because of labelling or advertising, we have been misguided and you’ve been unknowingly damaging your teeth.

Poor dental hygiene and diet also influences diseases that we face later in life, and this impacts on our healthcare system in a negative way. If people are educated, it will help to stem the flow on effects to the health care system, which will be a good thing for everyone.

A dentist doesn’t just fix teeth – they help shape and encourage us all to live a healthier lifestyle.

I am however very grateful for the current $1000 provided by our government to look after our kids’ dental hygiene. I am concerned though that if any of our children need braces that we won’t be able to afford it.

Natalie at Mummy Smiles

With four children at all different stages of their dental development, I am finding that I need to visit the dentist more than ever. My thoughts are that the more we protect their dental health now and help to prevent problems from developing, the healthier the children will be in the long term.

It’s amazing to think just how important dental care is for children and adults and I feel very strongly that if we educate and support families with their dental health that we will create a healthier and happier Australia.

I’d love to see a little more support for those children who need a bit more than just the basic check-ups and maintenance. With all of my children heading down the path of orthodontics, I am a little worried about the costs involved and the impact this will have on our family.

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
  • Podiatry
  • Physiotherapy
  • Psychulogy
  • Acupuncture
  • Remedial massage
  • Chiropractic
  • 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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