Dental Insurance

Dental Insurance

Unfortunately, insurance can’t help with dentist pain, however, it can take away some of the pain of the costs. Dentists in Australia are generally expensive especially if you’re without extras cover. Fortunately for you, with dental insurance, it covers its own costs. Your basic plan will tend to be around $13-$20/month.

Dental insurance – how does it work?

Extras cover include dental insurance as an optional form of health insurance.

Although, its not classified as your typical extra – its extremely important to have because your Medicare will not cover it. Dental health is expensive but it is very important to get.

The solution to this is private dental health insurance. There are three ways it can protect you based on the level of cover you choose; these are as follows:

  • It will help with costs around the general health of your teeth: Your regular trips to the dentist are assisted by dental insurance so you can maintain great long-term dental health.
  • It will help cover any current problems you have with your teeth: If teeth health is a problem, dental insurance can help cover the costs of those very expensive treatments such as dentures, crowns or root canals.
  • It will help pay for any emergency dental procedures: In the case of any emergency damage to your teeth, dental insurance can help protect you.

For any oral procedure that is too complicated to be performed at the dentist, your hospital cover may assist in protecting you. Although these cases are rare, it may help cover costs for the anaesthetist and the operating room – however the fees for the surgery itself would not be included.

What types of dental insurance are there?

Like the majority of insurance policies, you have the option of choosing how comprehensive or basic your dental cover can be. Whatever you choose will determine the cover you’ll receive for a range of treatment categories:

  • General dental: These are your normal dental procedures that are classified as preventative treatments such as teeth cleanings, check-ups, X-rays, fluoride treatments and small fillings. Your basic dental plan will generally cover the majority of these treatments.
  • Major dental: For procedures that fix decayed, missing or damaged teeth, major dental will pretty much cover it. Treatments include endodontics (root canals), periodontics (gum disease), crowns or complex fillings. To cover these treatments, you’ll need the comprehensive dental policy.
  • Orthodontics: For treatments that reposition/realign your jaw or teeth. A common example of this is braces which are used to help realign your teeth. To cover these treatments, you would again need a comprehensive dental policy.

Do I select the basic or comprehensive dental policy?

If all you’re searching for is basic check-ups for your teeth every year, you would only need to go as far as choosing a basic dental policy. Anything further than a couple dentist visits a year would most likely warrant the more comprehensive dental policies.

If you’re thinking of getting cover at the level of “major dental”, it’d be wise to carefully examine the policy you’re weighing up. Only because an insurer will typically separate the major dental category into smaller subcategories, allowing you to claim on treatment on a few plans but maybe on some others.

E.g. indirect restorations may be covered by a mid-level policy but not endodontics. You need to be careful because some of the appealing comprehensive plans could have hidden wait times and benefit limits for certain treatments.

Waiting periods and dental claims

Waiting periods are essentially a set-time you must wait before taking out health insurance on a policy to cover an expensive procedure. They help stop people from always claiming on their health insurance. Although it may not seem like it, it’s beneficial for both the health funds and policyholders, as excessive use without waiting periods would results in very high premiums.

  • Major dental. Six to twelve month waiting period is what you’d be looking at depending on what procedure you’re receiving.
  • General dental. Can be up to a two month wait or completely waived for the more basic treatments.

Sign up deals are a common way in which health funds will attract new members. These deals can allow you to claim instantly on extras like general dental. As for major dental procedures, you probably won’t find these in a sign up deal.

 Will the public health system cover my dental?

Medicare can cover you as an adult when:

  • If it is needed to protect the patient’s general health.
  • The general health of the patient is at risk
  • If it forms a part of a Medicare approved treatment, such as dental work prior to radiation treatment for oral cancer.
  • The oral treatment is a part of a Medicare procedure, like dental treatments before chemotherapy for a patient with oral cancer.

Dental-related hospitalisations can be covered by Medicare, however they probably won’t cover any follow-up treatments after the initial condition has been taken care of.

Child Dental Benefits Schedule (CDBS)

The CDBS is an Australian Government run program for an estimated 3 million qualified Australian children. It can give your children up to $1,000 worth of benefits which will last over two consecutive calendar years. These eligible dental services involve:

  • Examinations
  • X-rays
  • Teeth cleaning
  • Fissure sealing
  • Fillings
  • Root canals
  • Extractions
  • Partial dentures

Services can be given in a private or public clinic, however treatments such as cosmetic dental work or orthodontics are not available for cover, there is also no available benefits for procedures in a hospital.

To be eligible for benefits by the CDBS, your child must be Medicare eligible, between the ages of 2 and 17 within any particular time in a calendar year and must have received a particular grant from the Australian Government (for example, Family Tax Benefit A) within any particular time in a calendar year. For most situations, you’ll be notified at the beginning of the year if your child is eligible.

Can an extras policy give me more value from my cover?

If you already have an extras policy, it’d be wise to use it. These are a few ways in which your extras policy can get more value out of your dental health insurance.

  • Book your two yearly cleans. For good dental health, professional cleanings aren’t really optional but essential. So, if you have a dental policy, make sure you put your extras to use and book in for your twice-yearly cleans.
  • Ask your dentist for their opinion. Dentists will be able to inform you of treatments you’ll probably need down the line. Asking them for their opinion means you’d able to time your procedures for when you think you’d need them. It means you can postpone signing up to a comprehensive policy that you’d probably need for a future treatment. Make sure you time it correctly though in accordance with the waiting periods so you’re able to receive your treatment when you need it and avoid paying higher premiums for a longer amount of time.
  • Take advantage of your combined extras. If you’re already singed up for a combined extras policy, you’re potentially able to claim all your extras benefit solely on dental health. Barring your policy is accepting of this and you require a substantial amount of dental work, maybe avoid using your extras on the non-necessities like massages and keep it all for your dental.

Medicare and Emergency Dental

It is not common for Medicare to pay for dental treatments as well as emergency care. In the case that they do cover you, there are only three scenarios in which it will happen:

  • Your dental treatment is a part of another treatment. Cover will be provided for your dental work if it plays part in a Medicare-approved treatment, for example, a broken jaw could warrant the extraction of teeth before the doctor is able to repair the jaw. Although, you will not be covered by Medicare for treatments that follow after that condition has been provided for.
  • You are disadvantaged and under 18. Specific children are able to receive up to $1,000 worth of dental benefits over a consecutive two-year timeframe, but this only occurs if they already receive other benefits intended for children at a disadvantage such as Family Tax Benefit A. This situation is referred to as the Child Dental Benefit Schedule.
  • Your treatment is in an emergency room. If you are hospitalized and taken to an emergency room of a public hospital, Medicare will provide cover for treatments they give you even if your dental problems have nothing to do with your current health concern. E.g. If you are taken to an emergency room for a broken jaw but your tooth is in extreme pain, you can be treated for the tooth pain and Medicare will fully cover it.

Will emergency dental be covered by my private health insurance?

Unless you are a part of the select few who receive public assistance, private health insurance is probably your best bet in terms of covering emergency dental procedures. Private health insurers will help cover your dental work as a benefit of their extras policies.

Here’s what you need to keep an eye on when choosing an extras policy:

  • Making sure you have the right level of cover. Basic dental policies will cover your tooth removals, but nothing much further than that. Emergency procedures however, like your complex fillings, crowns or root canals fall under major dental treatment and thus will only be covered by a more comprehensive dental policy.
  • Be aware of the waiting periods: A waiting period of 2-12 months is what you’d expect when you first take out a new extras policy on basic procedures like tooth removals or the bigger treatments like root canals. In some instances, the insurer may waive the waiting period for the smaller basic treatments in order to keep your business, so we’d suggest asking them at the very least.

Insurers are willing to pay a certain percentage of your costs in relation to your annual benefit limits. The exact percentage they will pay is varied from insurer to insurer, however you can estimate that it’d be around the 60-80% mark.



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