In this article:
- What is dental insurance?
- Does Medicare cover dental treatments?
- What does dental insurance usually cover?
- How much can I claim on dental cover?
- Can I get complete dental coverage?
- What are the waiting periods for dental cover?
- Can I get dental cover with no waiting period?
- How to find the best dental insurance for your needs
What is dental insurance?
The term ‘dental insurance’ refers to health insurance that includes cover for dental treatment. Dental cover can be offered through an extras policy, as well as a hospital policy. That means you can be covered for dental treatments that occur outside of hospital (such as going to the dentist for a check-up or a filling) and inside of hospital (such as getting your wisdom teeth removed).
Does Medicare cover dental treatments?
Medicare covers some dental treatments for eligible children and adults (namely those who have a Health Care Card or Pensioner Concession Card). Because of the eligibility criteria, many people will have to cover the cost of dental treatments themselves. But, if you have a health insurance policy that includes dental cover, your insurer could contribute towards the cost.
What does dental insurance usually cover?
Dental cover can include general dental treatments such as regular check-ups and cleaning through to more complex treatments like root canals and dentures. The treatments or services that are covered will depend on the policy, including whether you are taking out an extras or hospital policy. Here’s a guide to what treatments are generally covered. Remember to read the insurance documents carefully so you have a good understanding of what is and isn’t covered.
Extras insurance with dental cover
There are two main types of extras dental cover: general dental and major dental. General dental typically covers part of the cost of routine dental treatments, such as check-ups, cleaning, filings, x-rays and more. General dental is covered by the majority (99%) of the extras policies on Canstar’s database, with the average cost of a policy being $643 per year.
Major dental is designed to cover more complex (and generally more expensive) dental procedures. Some of the treatments that may be covered include crowns, dentures and veneers, as well as treatment for periodontal (gum) disease. At the time of writing, major dental is covered by 80% of extras policies on Canstar’s database. These policies have an average annual premium of $739.
Extras policies may also include cover for endodontics (such as root canal treatments) and orthodontics (such as paying benefits towards braces). Some insurers include endodontics as part of major dental. At the time of writing, endodontics is covered by the majority of extras policies (80%) and orthodontics is covered by just over half (52%) of extras policies on Canstar’s database. The average annual cost of a policy with endodontics cover is $732, while the average annual cost of a policy with orthodontics cover is $843.
Hospital insurance with dental cover
Hospital policies can include cover for dental surgery done in a hospital. This could include procedures such as surgery to remove wisdom teeth or dental implant surgery.
Hospital policies are split into tiers based on the treatments they cover. The four main tiers are Gold, Silver, Bronze and Basic. Policies that are Silver and above are required to include dental surgery cover. However, there are many Basic Plus (70% on Canstar’s database) and Bronze Plus (100% on Canstar’s database) policies that also include dental surgery cover. ‘Plus’ policies are ones that include additional coverage above the minimum requirements. OSHC, Visitor and Corporate policies, as well as funds with restricted membership are excluded from these policy calculations.
Hospital policies that include dental cover are usually more expensive than those that don’t. For example, according to Canstar’s research, the average annual premium for a hospital policy with dental surgery cover is $1,734. In comparison, the average premium for a policy without cover is $1,065. That being said, dental cover isn’t the only factor driving this difference in cost. Other factors like varying levels of cover for other procedures also play a part.
How much can I claim on dental cover?
The amount you can claim will depend on your policy. For extras policies, insurers typically allow you to claim a percentage of the cost of your treatment or a set benefit amount. For example, your policy may allow you to claim 60% back on general dental services.
Extras typically also have annual limits, which is the maximum amount of money you can claim for a particular service. Insurers may also specify a combined annual limit which applies across a group of services. For example, a combined annual limit for general dental, major dental, physiotherapy and chiropractic.
Almost all health insurers have a lifetime limit for orthodontic benefits, according to the Private Health Insurance Ombudsman. This means that once you have claimed the maximum benefit, you won’t be able to claim further benefits during your lifetime.
Can I get complete dental coverage?
A number of funds offer 100% back on regular check-ups and other preventative services when you visit a dentist in the fund’s network. This is also known as no gap dental as you will pay nothing out-of-pocket if you are eligible. Preventative services typically include scale and clean and fluoride treatment, some funds may also include x-rays and mouthguards.
It’s worth checking with the individual fund to see what is and isn’t included and what other terms and conditions apply. For example, no gap dental will usually be subject to annual limits. The fund may also have a cap on the number of check-ups you can get 100% back on per year.
What are the waiting periods for dental cover?
The waiting period is the amount of time you have to wait before you can make your first claim. Waiting periods under extras policies can vary from provider to provider. According to the Ombudsman, some examples of typical waiting periods are two months for general dental, 12 months for major dental and one to three years for high-cost procedures such as orthodontics.
For hospital policies, the maximum waiting period an insurer can set for dental surgery is two months. However, longer waiting periods may apply for pre-existing conditions.
Can I get dental cover with no waiting period?
Some insurers offer to waive some waiting periods on extras for new customers. For example, there are a number of health insurers on Canstar’s database offering to waive two-month waiting periods on extras if you take out an eligible policy. This means you may be able to make a general dental claim straight away, depending on your policy. See some of the health insurance sign-up offers available this month.
Additionally, if you have already served a waiting period under one policy and switch to another insurer with the same or a lower level of cover, you will generally not have to re-serve the waiting period.
How to find the best dental insurance for your needs
If you’ve decided to take out health insurance with dental cover, it’s important to shop around so you can find a policy that suits your needs. When comparing policies, some questions you might like to consider include:
- What type of policy do you want? Hospital, extras or combined hospital and extras?
- Who do you need to cover? Are you single, in a couple or part of a family with children?
- What cover is important to you?
- What is your budget for premiums and excess payments?
- What are the annual limits?
- What are the waiting periods?
Canstar compares thousands of health insurance policies each year. You can use our comparison tool to compare policies by both price and coverage. Canstar’s Health Insurance Star Ratings can also help you find an award-winning health insurance policy that meets your dental health needs.
Additional reporting by Sean Callery.
Main image source: Jacob Lund/Shutterstock.com