Medicare provides cover for some people and certain dental treatments, but the eligibility criteria mean many of us need to foot the entire bill ourselves. However, if you have a health insurance policy that covers dental, your insurer could contribute towards the cost.
For example, depending on the policy, it could help cover part of the cost of dental check ups or simple treatments, such as getting a filling. But it’s perhaps for more complex and costly procedures where health insurance could be the difference between whether the dental work is affordable or not for some people.
According to Australia’s Adult Oral Health Tracker 2020, although more adults are experiencing toothache, less than half of us (48.8%) have had a dental check-up in the last 12 months. More than 30% of Australian adults have untreated tooth decay, and the prevalence of tooth decay and gum disease are both worsening.
Australian Dental Association (ADA) 2019 data suggests the average cost of having a full crown (veneer) is $1573. According to Private Healthcare Australia research, health insurance may cover nearly $700 of average crown costs. For dental surgeries that involve a trip to the hospital, the cost to the patient could be much more.
Here’s an overview of the kinds of health insurance policies that cover dental.
What type of hospital policies cover dental?
Some hospital policies will cover part of your costs if you need dental work carried out in a hospital. This could include procedures such as surgery to remove wisdom teeth, or dental implant surgery. All hospital policies in the Silver tier and above must include cover for dental surgery, but some insurers may also include a level of cover for dental surgery in their Bronze policies, while some may include a more restricted level of cover on their Basic hospital policies.
Source: www.canstar.com.au – 24/08/2020. Calculations exclude OSHC, Visitor and Corporate policies.
One of the main possible benefits of having dental cover through your hospital policy is that it will contribute towards the expenses you may incur if you make a successful claim. But there could be other advantages, such as having your choice of surgeon, being able to be treated in a private hospital, or potentially having a shorter waiting time for your operation.
It’s worth bearing in mind any exclusions that are listed on the policy, how much of an excess you would need to pay in the event of a claim and whether a waiting period applies to the policy after you take it out.
It’s also important to consider the cost of the policy premiums. Higher tier hospital policies with dental cover included are typically more expensive than policies that don’t cover dental. However, the inclusion of dental on a policy would not necessarily account for the entire difference in cost. For example, a Gold tier policy would typically cover a range of other conditions and treatments that Basic, Bronze and Silver policies would not.
Source: www.canstar.com.au – 24/08/2020. The Australian Government Private Health Insurance Rebate, Base Tier for under 65s, of 25.059% has been applied to premiums. Calculations exclude OSHC, Visitor and Corporate policies. Averages are calculated over multiple hospital tiers and excess options, and restricted cover for dental surgery is not considered. National average premiums based on state averages weighted by state population of insured persons, per APRA June 2020 Quarterly private health insurance statistics. *Cover for Dental Surgery is not the only factor driving difference in premiums; varying levels of cover for other procedures will also be contributing to the difference in average premiums.
What type of extras policies cover dental?
Dental cover that’s offered as part of health insurers’ extras policies is split into two categories: general dental and major dental. Depending on the level of extras included in your policy, you may be covered for just general dental, or both general and major dental.
What is general dental?
General dental covers part of the cost of routine dental treatments, like check ups, cleaning, fillings, x-rays and more. Policies with general dental may also contribute towards the cost of more complex procedures such as wisdom tooth extraction, but usually only where a trip to hospital is not required. General dental is covered by the majority (87%) of the extras policies on Canstar’s database.
What is major dental?
Major dental is designed to cover more complex – and generally more costly – dental procedures, and is usually only included in higher levels of extras cover. Some of the treatments that may be covered under major dental include root canals, crowns, dentures and veneers. Around two-thirds of the extras policies on Canstar’s database (66%) include major dental cover. As is the case with hospital policies, extras cover that includes dental is likely to be more expensive than policies that don’t. Policies with major dental also tend to cost more than policies with only general dental included.
Source: www.canstar.com.au – 24/08/2020. The Australian Government Private Health Insurance Rebate, Base Tier for under 65s, of 25.059% has been applied to premiums. Calculations exclude OSHC, Visitor and Corporate policies. National average premiums based on state averages weighted by state population of insured persons, per APRA June 2020 Quarterly private health insurance statistics.
What are the waiting periods for dental cover?
The waiting period is the amount of time you need to wait from when you purchase your policy to when you can make your first claim. For hospital policies, the maximum waiting period an insurer is allowed to set in most cases is two months, although longer waiting periods may apply in certain situations, such as for pre-existing conditions or obstetrics.
By contrast, waiting periods under extras policies can vary from provider to provider, but the Private Health Insurance Ombudsman gives the following examples of the waiting periods for dental services:
- General dental: two months
- Major dental (wisdom teeth): 12 months
- High-cost procedures such as orthodontics: one to three years
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 generally will not need to re-serve the waiting period.
Some insurers also opt to waive the waiting periods on certain policies for new customers as an incentive to help sign people up.
Main image source: Visual Generation (Shutterstock).