When you take out health insurance to cover you for dental fees, you should be aware that:
Each health fund determines what level of rebates it will pay, based on its own commercial requirements.
An important aim of some health funds is, quite appropriately, to make profits for their shareholders as well as to provide rebates for their customers.
The rebates payable on dental fees are unlikely, in many cases, to cover more than 60% for common dental items and may cover less than half the cost of complex and expensive procedures.
For some people, these rebates may be of assistance in offsetting some of the costs for more expensive procedures but some arrangements may not always represent value for money for routine dentistry for you and your family.
If you have a problem with your private health insurance, you should contact the fund directly. If you are unable to reach a satisfactory agreement with your fund, contact the Private Health Insurance Ombudsman, an independent body formed to help resolve complaints and provide advice and information. Before paying premiums for dental benefits, or selecting a particular benefit table, you should ensure that these costs represent value for you and your family.
Unlike Medicare, dental fees are not subsidised by the Federal Government and there is no recognised fee schedule.
Dental Insurance – Options, Reviews and Advice
Not everyone is fortunate enough to have a gold standard health insurance coverage to take care of every possible combination of health care situation.
When it comes to dealing with dental care, having a private dental health insurance plan is your best option to deal with unexpected dental costs.
However, what is the right type of dental coverage for you? Like most things in life – private dental coverage is not a ‘one size fits all’ solution, so picking the right plan from the outset is imperative. If you don’t, you’ll pay hundreds more than you need to, or worse, risk being improperly covered when you need it most.
There is an overwhelming number of plans to choose from, with different options available (and an overwhelming amount of fine print to read through).
Let’s clear up the dental health insurance myth in Australia so that you can make a confident and informed decision.
How It Works: Health Insurance Dental In Australia, you don’t specifically look for ONLY dental coverage per se, as dental coverage will fall under your health insurance plan.
Basic dental treatments are usually covered by your health insurance plan by default (regular check-ups, cleaning etc.) and you have the option to add on extras dental cover for an extra premium (which will cover you for larger dental procedures)
Types Of Coverage – What’s Best For You?
Typically, dental coverage is available in one of two ways in Australia: general and major dental. Exactly what is classified as general or major is not black or white; it varies from one health insurance provider to the next, but in general, according to PrivateHealth.gov.au:
General dental coverage: This refers to annual checkups, cleaning & fluoride treatment, minor fillings, and in general, most types of preventative dental work.
Cosmetic dental work, which is anything that enhances the appearance and is not medically necessary (e.g. teeth whitening or dental implants) is NOT covered by health funds or Medicare.
Lots of health funds offer basic levels of coverage as standard inclusions, with additional coverage options available as extras. Typically, the basic and extra’s coverage usually includes General dental procedures only.
Additional extras options are usually offered that include treatments under both General and Major dental categories.
“So, Should I go for a health fund that covers general dental, or look for a plan that covers general + extra coverage for major dental work?” Selection of an appropriate type of policy is largely a function of your individual dental coverage requirements – For example:
Young individuals (or couples), whose dental health is relatively good, may opt for general coverage
Families or elderly individuals may be better served to opt for a plan that provides major dental coverage.
If you are relatively young and your teeth are in good health, there is generally no need to spend money on a plan that covers you for major dental complications. A basic plan that covers you for general dental will be good enough; just make sure you take advantage of the discounted preventive dental benefits to ensure your teeth stay in good shape!
If you feel like you will need an expensive procedure at some point in the future, for example, dental implants or dental veneers, then a higher level of cover is going to cost you more in the short term but save you more in the long run.
How To Choose Dental Health Insurance
With so many health insurance providers available to choose from, it’s hard to decide whom to select as your provider of choice. Always do your own research and make decisions based on your own unique circumstances (rather than taking advice from your know-it-all neighbour)
Start by looking at the following obvious factors:
Extra dental coverage may be required as you get older The state of your dental health
Some seniors have enviable dental health, while some young adults may have severe dental issues. Select your coverage based on what your individual needs are. Your financial state
Individuals that are in a high-income bracket, or those that are already enrolled in an employer-sponsored “gold standard” health care plan may not find extra coverage overly beneficial. The economics of it.
Though individuals may enjoy great dental health, dental insurance should be decided upon based on the economies of the collective family unit. The larger the family, the greater the potential for dental expenditure, which might require extra coverage. When choosing your insurance provider, look for freebies that are offered
What will be my out of pocket expenses be?
Always ask what out of pocket expenses will be for general and major dental procedures, to get a good idea of how much you will benefit. Even though you are paying for coverage, there will generally be out of pocket expenses. Pick 5 dental procedures (a few general, and a few major) and ask a few health insurance providers what your out-of-pocket expenses will be.
Do you offer ‘no gaps’ benefits? Some funds offer NO GAP provisions to their members; what that means is that members have no gap (out of pocket payment) to incur when they visit their dentist for procedures such as check-ups, removal of plaque, cleaning, x-rays and other routine treatments. Most good providers will offer a no-gap option nowadays.
PRO TIP: Keep your eye out for special offers from funds, during which they may waive (or reduce) the wait times associated with some of the extras. This is the best time to sign up to a new health insurance provider during a sale!
The Best Dental Insurance For General Dental Coverage
Chances are that you already have private health coverage, but the confusing question is, exactly what type of dental work are you covered for? If you have ancillary or extras with your health insurance cover, you should be able to get free (or low cost) preventative dental care, which is the best way to prevent expensive dental complications from arriving in the future.
PRO TIP: If your current health insurance provider does not provide you with reduced cost or free preventative dental care, consider moving to a company that does. Prevention is always better than a cure.
“Coverage for major dental procedures in Australia is quite weak”
And you’re right! Unfortunately, Australian health insurance providers do not provide amazing benefits by any means for patients seeking major dental work. Considering that some procedures can cost in the tens of thousands of dollars, it’s just too risky in their eyes.
While certain health providers do provide levels of coverage of up to $2000, you can only access this rebate once you’ve been with the company for 5 + years.
Your Preparation: The Best Dental CoverageHealth insurance exists to ensure that you’re protected in case of unexpected dental costs (e.g. Root Canal Costs which can be VERY VERY expensive if you’re not prepared, or wisdom teeth removal, which always seem to cost more than you were quoted for!)
As we age, we become more susceptible to diseases, including dental decay and orally borne illnesses that’s a fact we have to live with.
As we’ve revealed, coverage for major dental work is limited in Australia, meaning you’ll likely have to fork out a good deal of your own savings if you unexpectedly require any type of major dental work. So what can you do about?
Prevention is better than the cure – always strive to take care of your teeth and this means making use of your health funds general/preventative benefits: make use of the free regular checkups and subsidies preventive dental care!
Don’t leave choosing a dental health plan until it’s too late – joins a policy that has great general dental coverage ASAP and starts making use of your preventative dental care benefits.
Always read the fine print – Before signing up to a plan, to ensure you’re getting the best benefits your money can buy. These points are what you should be looking at.
Plan ahead for the chance of major dental work – You now know that your health insurance coverage will be limited and weak at best, so have a backup plan ready to go. This can be either putting away savings, asking your dentist if they offer payment plans, or considering dental tourism to save money.
Being covered by an appropriate dental health insurance plan will help relieve the stress of having to deal with such unexpected costs.