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Last Updated on 7 October 2019

Medicare and Dental Cover

Medicare does not cover most out-of-hospital services and if you need any type of dental treatment, you will need Extras cover or to pay out of pocket for dental services.  You should consider the purchase of an Extras policy before you need costly dental care because some treatment can be very expensive if you do not have Extras cover.

What Does Medicare Cover for Dental Services?

Medicare does not extend to dental services for adults but there is some support for children.

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 Cover?

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 Cover?

For children and teens who qualify for 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 cover 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 they are eligible, you can make an appointment with a dental provider and let them know you are eligible for the Medicare Child Dental Benefits Schedule.

When you visit a provider, the dental care professional will discuss cover, 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 support 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 Extras cover.  This dental guide explains dental cover, private dental policies, and how to get the dental services you need.

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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