Our overall well-being is intricately connected to our oral health. Maintaining great oral health requires regular check-ups and cleanings, and more extensive treatments on occasion. Given that it plays such a crucial role in our health and quality of life,many people ask themselves, ‘Should I purchase dental insurance?
We’ll discuss the intricacies of dental insurance, offering clarity and insights to help you make an informed decision.
What is dental insurance?
Dental insurance, often included in ancillary or extras cover, is a part of private health insurance in Australia specifically for dental treatments. It works similarly to general health insurance, where individuals pay regular premiums to a health fund, which in return provides coverage for a range of dental services.
Here’s a breakdown of how dental cover typically works:
Premiums: Policyholders pay premiums, either monthly or annually, to their chosen health fund.
Coverage: The specifics of what is covered under dental insurance can vary widely. It’s common for policies to cover preventive care (like check-ups and cleanings), basic dental procedures (like fillings and extractions) and major procedures (such as crowns and root canals). Some policies even include orthodontics (such as clear aligners or braces). Cosmetic dentistry, like teeth whitening, is often included with mid to high levels of cover.
Benefits: Depending on the policy’s terms, the health fund will cover a percentage of the costs or a specific amount. Policyholders usually incur a copayment or coinsurance for each service, with the health fund covering the remainder, subject to the policy’s coverage limits.
Annual limits: Many dental policies come with an annual maximum benefit. This is the cap on what the health fund will reimburse in a given year. The policyholder is responsible for covering costs that go over this cap.
Deductible: Some policies have a deductible—a set amount the policyholder must first pay before the insurance coverage starts to bear the costs.
Waiting periods: Dental policies might have waiting periods for certain procedures. These are durations when the specific services are not covered. The waiting periods are typically as follows:
- General dental cover: 2 months
- Major dental cover: 12 months
- Orthodontics: 12 months
Does Medicare cover dental services?
In Australia, Medicare predominantly caters to medical treatments and services, with dental services generally not covered. However, there are exceptions. The Child Dental Benefits Schedule (CDBS) allows eligible children to access free essential dental services under Medicare. Additionally, adults holding a Health Care Card or Pensioner Concession Card may also be eligible for certain dental services covered by Medicare.
Over half of Australians have extras cover
According to the latest quarterly report by APRA (the Australian Prudential Regulation Authority) in June 2023, approximately 55% of Australians have ancillary or extras cover as part of their private health insurance policies. So, there’s a significant chance that you are one of these people, even if you are unaware.
Dental services are a crucial component of ancillary or extras cover, and many Australians rely on private health insurance to help manage the costs of dental treatments and procedures. During the second quarter of 2023, private health insurance companies collectively paid a substantial total amount of $829.2 million to cover dental services for their policyholders.
Dental coverage by Australian health insurance providers
Below is a comparison table featuring popular Australian health insurance providers offering coverage for dental services through their extras policies. These policies cover major dental services, orthodontics and endodontics. Additionally, providers may offer different rate options tailored to single individuals, couples, families or single parents.
| Provider | Policy Name | Supporting Documents | Rebates | Policy Type | Price/month as of 26/09/2023 |
| Bupa | Top Extras | Policy cover | Up to 70% | Families | $200.01 |
| Medibank | My Choice Extras Family | Policy cover | Up to 60% | Families | $98.76 |
| nib | Top Extras | Policy cover | Up to 75% | Families | $284.51 |
| HCF | Vital Extras | Policy cover | Set amounts per item | Families | $121.90 |
| Australian Unity | Active Extras | Policy cover | Set amounts per item | Families | $117.30 |
| ahm (by Medibank) | Super Extras | Policy cover | Set amounts per item | Families | $181.65 |
| CBHS Health Fund | Prestige (Gold) | Policy cover | Set amounts per item | Families | $267.73 |
| GMHBA | Mid Extras Set Benefits | Policy cover | Set amounts per item 70% on orthodontics | 1 Adult, 1 Dependent | $88.50 |
If you’d like to get more information about private health insurance providers, we encourage you to explore the official Private Health website. You can access a wealth of resources and details about registered health insurers in Australia by visiting this Australian Government website: Health Insurers.
Did you know that in Australia, you can receive the Private Health Insurance Rebate as a tax offset when you file your annual tax return?
The Private Health Insurance Rebate is designed to make private health insurance more affordable for Australians while reducing the burden on the public healthcare system.
When you file your tax return, you have the option to claim the rebate as a tax offset, which can reduce the amount of tax you owe or increase your tax refund. To claim the rebate through your tax return, you’ll need to provide information about your private health insurance policy and income.
The rebate amount you receive depends on factors such as your age, income, and the type of policy you hold (single or family). The Australian Taxation Office (ATO) adjusts the income thresholds and rebate rates annually, so it’s important to check the current rates and eligibility criteria when you file your taxes.
Claiming the Private Health Insurance Rebate as a tax offset is one of the ways Australians can benefit from having private health insurance, as it provides a financial incentive for maintaining private coverage. However, individuals can also choose to receive the rebate as a premium reduction from their insurer, which lowers their monthly insurance costs.
To determine how much rebate you can get, you can use the Private Health Insurance Rebate Calculator or call the tax office on 132 861.
Prospective benefits of dental insurance
Predictable costs: Dental insurance can make dental costs more predictable. You pay a set premium and know in advance what portion of your dental expenses will be covered.
Prevention and early intervention: Insurance plans typically cover the full cost or a significant portion of preventive services, encouraging regular checkups and early intervention for dental issues, potentially saving money and discomfort in the long term.
Mitigation of high expenses: In the event of a dental emergency or need for major work, having insurance can significantly offset potentially high out-of-pocket expenses.
Prospective benefits of dental insurance
Limited coverage: Dental insurance does not cover all procedures, and you may still have to pay a lot of money for extensive dental work or cosmetic procedures.
Premium costs: The cost of the premiums may outweigh the benefits, especially if you generally have good oral health and only need preventive care, which is relatively low-cost even without insurance.
Waiting periods: Some policies have waiting periods for certain procedures, which can be problematic if you need immediate care.
Annual limits: Many dental insurance plans have an annual maximum payout, after which you must pay for all additional costs.
Considerations
Evaluate your oral health: If you have generally good dental health and only need preventive care, dental insurance may not be cost-effective. Conversely, if you anticipate needing significant dental work, insurance can be a valuable investment..
Get treatment quotes: If you know you’ll need specific procedures, get cost estimates. This can help you compare potential out-of-pocket costs against yearly premiums and covered benefits.
Consider other options: Some dental clinics offer promotions or financing options that might be more cost-effective than insurance.
Research different plans: Dental insurance isn’t one-size-fits-all. Look into different plans to find one that suits your needs and budget. Consider factors like coverage percentages, annual maximums, and any waiting periods.
Is dental insurance worth it?
The decision to purchase dental insurance should align with your unique circumstances and needs. Given the profound connection between oral health and overall wellness, it is wise for you to prioritise your dental well-being. Before committing to any contract or purchase, it’s essential to balance the costs against the benefits, examine the specifics of policies and consider the full range of effective alternative solutions.
Keep in mind that a proactive approach to your dental care is priceless, as regular check-ups can proactively address immediate dental concerns and contribute to your overall health. In the end, the right decision should grant you peace of mind and financial security, ensuring that you’re well-equipped to keep your smile healthy for a lifetime.
