Dental Cover & Health Insurance

Want a winning smile? With dental insurance, you can maintain your dental health without the exorbitant costs.

In Australia, dental treatment can be expensive, especially if you don’t have private health insurance. Beyond the fear of drilling, the high cost for dental care is a big reason why many Aussies want to stay well clear of the dentist.

Unfortunately, you only get one set of teeth and keeping those pearly whites in great health requires more than just daily brushing and flossing. If you want to avoid extractions and root canals, maintenance is key.

The question is how do you choose the best health insurance for dental that suits your current situation? It might be tempting to select the first cheap dental insurance policy you find, but understanding your options will ensure all your needs are covered at the right price.

The types of available dental cover

Private health funds will offer dental as part of your health insurance policy. Dental cover only plans are relatively rare, with most benefits falling under a hospital or extras cover.

HOSPITAL COVER

If you have hospital cover, you’ll be able to claim in-patient dental procedures, such as the removal of wisdom teeth. Depending on your level of hospital cover, you may be able to claim the entire cost of the dental procedure including accommodation, theatre and the anaesthetist fees. In this scenario, Medicare will cover some of the expenses and your health fund will pay the remaining.

EXTRAS COVER

Most of the benefits for dental services will be covered under extras health insurance, also known as general treatment or ancillary cover. Insurance funds divide the cover of dental services into two classes: general dental and major dental. What’s covered under general and major dental Depending on your level of extras cover, you’ll be covered for general dental or major dental services.

GENERAL DENTAL

Most basic extras policies cover general dental which includes cleaning, small fillings, plaque removal and X-rays. This level of cover typically appeals to those who are young, single and healthy without a complicated dental history. It suits those people who visit the dentist a couple of times a year for a check-up and only require minor treatments to maintain their winning smile.

MAJOR DENTAL

Major dental is typically covered under the policies of higher extras cover which generally covers surgery and emergency treatment. Major dental typically includes complex and expensive procedures like braces, crowns, wisdom teeth removal, bridges and root canals. You can also receive cover for orthodontic and endodontic works. Families and elderly people generally opt for major dental cover.

Does Medicare cover dental care?

As an adult, Medicare only covers the cost of dental treatment when it’s essential to protect your general health. The public health system may also cover the cost of dental work if it’s part of a Medicare approved treatment. For example, dental treatment required prior to radiation for oral cancer.

Medicare may also cover the costs if you required hospitalisation following a dental-related procedure. For example, if you need to be admitted for treatment of an infection that developed after having a wisdom tooth extracted.

Typically, Medicare will not pay for any follow-up dental treatment required once the general health condition has been resolved. The fees for specialists not related to the treated condition are also not covered.

Are you eligible for the Child Dental Benefits Schedule?

The Australian Government introduced a program known as the Child Dental Benefits Schedule (CDBS) which 3 million children are eligible for. Under the scheme, children can receive up to $1,000 in benefits over two consecutive calendar years.

The CDBS may cover the cost of dental services in a public or private clinic such as examinations, cleaning, fillings, X-rays, root canals, extractions, partial dentures and fissure sealing. Orthodontic, cosmetic dental and treatments in a hospital are not covered under CDBS.

To be eligible for the CDBS the child must:

Aged between 2 – 17 years old
Be eligible for Medicare
Have received financial assistance from the Australian Government such as Family Tax Benefit A

In most cases, if your child is eligible for the CDBS, you’ll be notified at the beginning of the year.

Compare & Join

There’s no one size fits all when it comes to private dental insurance. That’s why comparing different policy options to find the right plan for you is vital. If you don’t, you’re likely to be paying much more than you need or risk being improperly covered when unexpected dental costs arise. Don’t get caught out - take advantage of our comparison tool to find the right plan for you.

OUT-OF-POCKET EXPENSES, LIMITS AND WAITING PERIODS

The level of dental cover and the insurance fund you choose will determine 3 important factors:

your out-of-pocket expenses
the limits of your cover
when you can claim.

Some procedures will be covered 100% by your insurer and Medicare. However, there will be other dental treatments where you’ll be charged an out-of-pocket expense, otherwise known as a medical gap. It’s worth checking with your potential fund to understand the gap cover arrangements and any excesses that may need to be paid.

Additionally, there will be set limits as to how much dental treatment you can claim on your dental insurance policy. Some will have no limits for certain services like preventable dental check-ups and others will apply annual limits. For the more expensive treatments like orthodontics, there’s likely to be a lifetime limit. Typically, the higher the annual limits, the more you’ll save on premiums.

Extra policies have waiting periods that are set by the individual health insurer. These are in place to prohibit people from taking out health insurance right before they have to undergo an expensive root canal or get braces.

For major dental, you can expect to wait anywhere from 6 – 12 months depending on your fund and the type of treatment. For general dental, waiting periods can be as little as 2 months. In some cases, the waiting period of minor treatments such as preventive check-ups will be waived entirely.

Saving with no gap dental cover

Health funds don’t want to pay for expensive dental work just as much as you don’t want to endure it! That’s why many funds offer a “no gap” dental cover option to encourage you to maintain your dental health and reduce your need for expensive treatments later in life.

With the no gap scheme, your health fund will cover any out-of-pocket expenses you may incur after one of the covered preventative treatments. These treatments are designed to reduce the occurrence of more serious dental problems developing.

Some of the dental services that may be covered by a no gap dental scheme include:

Initial dental check-ups

Preventative examinations

Scale and clean

Topical fluoride treatment

Basic fillings

X-rays

Custom made mouthguards for sports

To be eligible for gap free dental you must receive treatment from a dentist who is affiliated with your insurer. That’s a small price to pay for a potentially big saving!

By making these preventative treatments more affordable and accessible for their members, health funds are protecting themselves from having to pay out for more expensive procedures. They’re also encouraging you to look after your own health and finances too!

THE ADVANTAGES AND DISADVANTAGES OF A DENTAL PLAN

Beyond dental insurance for fillings, cleaning and orthodontics, some people choose to take out a discount dental plan. This is a membership-based program which results in discounted prices in exchange for an annual fee.

Unlike dental insurance, the dental plan does not cover the costs of the treatment. It only provides a discount from a network of participating dentists.

The advantages of a dental plan are that the membership fees are relatively low and you’ll receive discounts on your health care. There are also no waiting periods that need to be served before you’re able to claim.

The main disadvantage of the discounted dental plan is that you can’t choose your own dentists to treat you unless they participate in the scheme. There’s also no guarantee the discounts will cover your entire bill.

Dental insurance on the other hand, does allow you to choose your own dentist. There’s a wide range of services offered where your costs are fully or partially covered. The downside is that you’ll have to serve a waiting period before you can claim and your benefit limit will cap the number of times you can claim per year.

What to consider when comparing dental cover

To find the right dental cover for you and your family you’ll need to consider a variety of factors. Taking out cover which doesn’t take into account your personal needs will be a waste of money.

Here are a few things you should consider when comparing dental policies:

AGE

Unfortunately, as you get older more things need fine tuning. You may have noticed your body is a little stiffer or your mind is a little less sharp. Our teeth health can also decline as we age, which is why major dental cover is popular amongst those entering the golden years.

FAMILY

Dental care for children can be expensive, especially if they require orthodontic treatment such as braces. It may be more financially viable to be protected by dental cover, especially if you have more than one child.

FINANCES

The premiums you’re able to afford will dictate the level of dental cover you can choose. If you earn a high income, major dental insurance will be more attainable than someone of a lower income. If you’re eligible for CDBS or a dental plan, private health insurance may be unnecessary.

DENTAL HEALTH HISTORY

Consider your current and past dental health history to help you assess the level of cover you’ll benefit most from. Family history is also important to take into account, especially if you have children. If there’s a history of crooked teeth for example, dental insurance for braces will be at the top of your list!

ANNUAL LIMITS

Even if you dread the dentist, the thought of accessing cheap dental treatments forever sounds appealing. Unfortunately, most funds impose annual limits on the amount you can claim.

WAITING PERIODS

Waiting periods on dental care and other extras are set by each health fund. This means the amount of time before you can claim will vary. General dental treatments typically only have a 2 month waiting period. However, dental insurance for orthodontics, may have a waiting period of 12 months. It’s worth keeping your eye out for general and major dental insurance no waiting period promotions.

OUT-OF-POCKET EXPENSES

Depending on the dental procedure required, you may find there are expenses you’ll need to pay that are beyond your health insurance benefit. Asking the fund about potential out-of-pocket expenses can save you the surprise of incurring unexpected costs.

GAP FREE DENTAL

Some funds will offer a no-gap dental program. This means you’ll have no out-of-pocket expenses when you receive preventative treatment from an affiliated dentist. This saves you money and maintains your dental health.