Health insurance for orthodontics and braces

Orthodontic cover allows you to claim a ‘benefit’ for orthodontic treatment or services, such as braces, or invisalign. The benefit amount you can claim, which can be either a dollar amount or percentage amount of the service or treatment cost, will depend on the fund and policy you go with. You typically cannot claim 100% of the costs with an orthodontics cover, meaning you’ll likely have to pay out-of-pocket for orthodontic treatments and services.

For example, if you were claiming $4,500 for clear braces and your policy allows for a 70% benefit claim for orthodontics, the fund will pay for $3,150 of the costs, leaving you to pay $1,350 out-of-pocket.

The overall cost for orthodontics will depend on a variety of factors, including your chosen orthodontic practice, the duration of treatment and your individual needs. According to Orthodontics Australia, on average, an 18 month treatment plan is likely to cost between $3,500 to $9,000.

The type of braces you choose will also have an affect on the overall price. At the time of writing, these are some figures from Orthodontics Australia on the typical average range for each of the different types of braces:

• Metal braces – $6,000 – $11,000
• Ceramic braces – $6,500 – $9,500
• Lingual braces – $9,500 – $15,000
• Invisialign/clear aligners – $6,500 – $9,500

The best orthodontics health insurance cover for you will depend on your own individual situation and circumstances. Factors to consider when comparing orthodontics cover include:

• Benefit: although this will depend on the fund and policy, you generally can’t claim for the total cost of an orthodontic treatment or service. Instead, you will be covered for the outlined benefit amount in the policy, which can either be a stated dollar amount or as a percentage amount of the total cost. You can find the exact benefit amount you’re able to claim in the policy’s product disclosure statement and terms and conditions.
• Costs: this will vary depending on a variety of factors, but keep in mind that cheapest is not always better. It’s worth thoroughly comparing different policies and reading through the product disclosure statement and terms carefully before committing to a policy.
• Waiting period: most extras health insurance policies have a waiting period you must serve before you’re able to make a claim. The period for each type of medical service will vary depending on the fund and policy so it’s worth taking this into account, particularly if you require orthodontics or braces cover relatively soon.
• Annual and lifetime limit: most policies will have an annual limit on how much you can claim each financial year. But orthodontics in particular tend to also have a lifetime limit, which limits the total amount you can claim in a lifetime across all insurers.

Since an exclusive orthotonics-only health insurance is not easy to come by, it’s also worth considering and factoring in what other potential general health services you might want to include in your policy, such as general dental, optical or physiotherapy.

Most health insurance policies generally have a waiting period for orthodontics that you will have to serve before you’re able to make a claim. Based on standalone extras only health insurance policies on Canstar’s Database, the waiting period for orthodontics cover can range from 12 months to 24 months.

But, if you can’t wait, there are specific scenarios where it could be possible to have your waiting period waived, such as:

• changing to a different policy with a similar or lower level of cover, and
• special offers to waive policy waiting periods.

Learn more: Can I waive my waiting period for health insurance?

Most health funds will have an annual limit that you can claim each financial year, as well as a lifetime limit for orthodontics cover. The maximum limit you’ll be able to claim will differ depending on the health fund and policy.

But keep in mind that the lifetime limit is applied across all health funds. This means if you’ve claimed the full amount on your policy’s lifetime limit and change to a new insurer, your new insurer may deduct the already claimed benefits from your new policy’s lifetime limit.

It’s a good idea to check with the health insurance provider for details if you have any concerns regarding prior claims you’ve made for orthodontics.

Medicare offers dental care rebates for adults in certain scenarios. But even if you’re eligible, not all states and territories provide orthodontic treatment and services under Medicare.

At the time of writing, these are the states and territories that include public orthodontic services for those that are eligible under Medicare:

• South Australia (specifically for banding)
• Queensland (management of simple orthodontic issues)
• Northern Territory

Learn more: Does Medicare cover dental?

Although children can also be eligible for dental care under the Child Dental Benefits Schedule (CDBS), CDBS does not cover orthodontics.