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Last Updated on 7 October 2019

Orthodontics and Private Health Insurance

Orthodontia is a form of dentistry that focuses on studying and treating issues such as improper bites, tooth irregularities and uneven jaw relationships. Both dentists and orthodontists are concerned with your oral health. So, what do they do differently?

Dentists and orthodontists undergo different types of training, and therefore, offer different kinds of services.

When you visit the dentist, you will most likely be checking up on the health of your teeth/gums, and in some cases, undergoing dental work or cleaning to improve your oral health.

Orthodontists are dentists who have undertaken further specialist training in orthodontics. They don’t perform routine dentistry. When you visit the orthodontist, you will be checking up on the physical structure of your jaw and bite to study irregularities that could be problematic (both now and in the future).

Orthodontic treatment is not covered under Medicare. This means you’ll have to pay for orthodontic treatment costs out of your pocket, or purchase private health insurance with orthodontic cover.

Key Points
  • Orthodontic treatments will vary patient-to-patient, and your age may determine which treatment plan is best for you. Treatment is less complicated while you are young as your jaw is still growing. As you enter adulthood, your jaw will ‘fix’ into a fully-grown position.
  • If you’re after coverage for orthodontics, you must select a policy that covers orthodontic services. Most policies that cover major dental services will also cover orthodontics – but not all.
  • Upon purchasing a new policy, you will generally need to wait 12 months before making an orthodontic claim.

What is Orthodontics

Orthodontists are concerned with:

  • Diagnosing and treating malocclusions such as overbites, underbites, cross-bites, reverse bites and tooth crowding/crooked teeth
  • Treating misaligned jaw & tooth irregularities
  • Impacted teeth (teeth that did not erupt from underneath the gum)
  • Gaps and spaces between the teeth

Straightening teeth, or fixing a misaligned bite not only boosts your confidence, but improves your oral health, too. For example, it makes cleaning your teeth easier, and can prevent plaque build-up in areas where teeth are covered due to crowding.

What orthodontic treatments fix the issues noted above?

  • Braces (clear, ceramic and metal)
  • Lingual braces (braces behind the teeth)
  • Invisalign (clear aligners that look similar to retainers)
  • Palate expander (plate on the upper jaw)
  • Lip and cheek bumpers (wire, usually wrapped in plastic)
  • Headgear

Note that some of these treatments may go hand in hand. For example, a patient may require a palate expander followed by braces. Depending on your case, it may also be possible to have both of these appliances at the same time.

Your orthodontist will be able to talk you through the options. Ask questions or get a second opinion if you are unsure or uncomfortable about a part of the process or treatment plan.

See below for a quick explanation of each appliance listed above.

Orthodontic Treatment for Kids

It’s not uncommon for a child to require orthodontic treatment. Jaw misalignment and/or crowding of teeth can occur for a number of reasons. These reasons include:

  • A difference in size between the upper and lower jaws (causing a misaligned bite)
  • Tooth size (for example, bigger teeth in a smaller mouth can cause overcrowding or overbite)
  • Birth defects such as cleft lip and palate (less common)

Often, it’s recommended to get your child’s teeth checked by an orthodontist while they are young, because their jaws have not yet set in their permanent adult position. Because of this, it may be possible to expand/move the jaws.

Treatment may get more complicated once the jaws become fixed in adulthood.

Orthodontic Treatment for Adults

Orthodontic treatment for adults is a little more complicated, as the option to widen your jaw may no longer be available. Once the jaw is fixed in place, it becomes more difficult to shift the teeth. However, there are ways around this. Treatments for malocclusions include:

  • Traditional braces
  • Lingual braces
  • Invisalign (clear aligners)

One of the above treatments may also involve extractions. This is because the process of moving teeth into new, corrected positions requires both space and pressure. Your braces or clear aligners will shift your teeth, but they can only do this when there is adequate space for your teeth to move into.

If you have a smaller mouth/jaw with no gaps between your teeth, you may require tooth extraction. It’s best to speak to an orthodontist about which treatment plans are available for your individual case. What works for one patient will not be viable for another.

In saying this, if you are uncomfortable or unsure about your treatment plan, you should ask questions, enquire about alternative options and make sure you understand what your specific treatment plan involves from start to finish.

Private Health Insurance and Orthodontics

If you’re looking to purchase private health insurance to cover orthodontic treatment, you will need to select a policy that covers orthodontic treatment. Most policies that cover major dental services will also cover orthodontics – but not all.

What’s the difference between general and major dental? General dental covers things like teeth cleaning, small fillings and dental x-rays. Major dental covers more advanced procedures including crowns, bridges, dentures, and, in most cases, orthodontic care.

When comparing policies in regards to dental cover, consider the following:

  • What types of orthodontic treatments are covered.
  • Who can provide treatment. Most health funds pay less for orthodontic treatment provided by a dentist than for an orthodontist (an orthodontic specialist).
  • What the lifetime limit is on orthodontic benefits. Once the limit is reached, benefits no longer re-accrue and you may not claim any further orthodontic benefits over your lifetime.
  • What the waiting period looks like. Most health funds impose a 12-month waiting period.
  • How quickly benefits accrue. Some policies have starting limits of cover, which increase each year after the initial 12 month waiting period. Annual benefits increase until the maximum benefit is reached. Other policies pay a fixed benefit per year.

Policy Limits and Waiting Periods

The standard waiting period for orthodontic cover is twelve months. This means that if you require any major dental work or orthodontic treatments before the twelve months is up, you will need to pay for these expenses out of your own pocket.

Once this waiting period is over, the amount of cover you receive is determined based on whether you have an accrued benefit policy or a fixed benefit policy.

So, what’s the difference?

The chart below shows you an example of an accrued benefit policy. Note the difference in yearly benefits increases each year until reaching the capped limit of $1100 per year.

Coverage for Orthodontic Treatment

Number of Years

Are No Gap Policies Available?

Unfortunately health funds do not provide ‘no gap’ policies for orthodontic treatment. Generous benefits are available in some instances but there will always be out-of-pocket costs to pay.

Some funds do, however, provide no gap policies for preventative dental care, which includes treatments and services such as check-ups, cleaning and scaling, fluoride treatments and x-rays.

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

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