Do you avoid dental visits because of the cost?
So do one in five Australian adults!
Dental health insurance can offset dental care costs, but policies are far from equal. Learn how dental health insurance works, including what’s covered under different policies, pitfalls to look out for, and how to find a plan to suit your needs.
Dental health cover isn’t a standalone type of health insurance. Rather, it usually comes as an ‘extras’ cover attached to your private health insurance policy.
Private dental health insurance might be used to help pay for things like regular dental check-ups, cleaning, and minor fillings. It might also offset some of the cost of larger procedures, such as crowns, bridges and denture fittings.
Additionally, a private hospital policy can contribute towards the cost of hospital-based dental treatments, such as wisdom teeth extractions.
Private health dental insurance comes in different coverage levels.
Dental extras policies typically provide coverage for a range of dental services that can be divided into three groups.
This category includes preventative care and basic dental procedures, such as:
This category covers more involved dental treatments, such as:
These may also be included under major dental cover. Endodontic work involves complex procedures like root canal therapy. Orthodontic work involves correcting teeth alignment, typically with braces.
This will vary according to your private health provider and policy. Extras policies can differ significantly between private health funds. Depending on your coverage level, you may only receive funding towards some of the above dental treatments. For example, complex procedures such as orthodontic and endodontic work may only be covered under higher-level extras policies. Or a procedure covered under general dental in one policy may be deemed as major dental by another, and vice versa.
When it comes to choosing the best dental health insurance for you or your family, there are several factors to consider. First, it’s vital to know exactly what you’re covered for, so review policy details carefully.
If you’re new to buying dental health insurance, it’s important to understand how benefit payments work. Health funds set limits on how much they’ll pay for dental treatments in two ways.
With a set benefit, the health fund pays a fixed amount towards the cost of eligible dental treatments, regardless of how much your dentist charges. For example, if your dentist charges $220 for a check-up, clean and fluoride treatment, and your fund pays a set fee of $105 for this service, you’ll have a $115 out-of-pocket expense.
With a percentage benefit, your fund will pay back a certain percentage of your treatment cost. Using the example above, imagine your fund pays a 60 per cent benefit. You’ll be covered for $132 of the $220 cost, leaving you $88 out of pocket.
Some funds offer a full cover option, also known as ‘no-gap’ insurance, for preventative dental treatments such as routine cleans, X-rays and fluoride treatments. However, you’ll still need to pay something towards larger procedures.
The amount different health funds and policies cover varies significantly. The Commonwealth Ombudsman’s 2020 State of the Health Funds Report found the average costs covered for general dental treatment ranged widely, from as low as 33.5 per cent right up to 74.4 per cent[i].
Most extras policies have a maximum limit each covered person can claim per year. If you’re purchasing a policy for your family, it’s worth checking the total each person is covered for.
As well as per person limits, some plans have annual limits. If your annual limit is $1,200, for example, any dental expenses beyond this amount will need to be paid from your own pocket.
Clearly, the benefit amount your chosen fund pays, along with benefit limits, can make a huge difference to your budget.
Some expert guidance, like we provide at Fair Heath Care Alliance, can help you navigate the complexities of benefit payments and find a plan to suit your needs.
When choosing private dental insurance, considering a few factors can be helpful.
Under private health insurance, dental coverage usually comes with a waiting period. These are in place to deter people from taking out a dental insurance policy just to pay for a major procedure.
The length of time you’ll have to wait to use private dental insurance depends on several things, including your coverage level, policy rules, whether you’re switching to a new fund, and the type of dental procedure. For example, you’ll typically need to wait an average of two to six months for preventative dental treatments and 12 months for major dental work.
It’s therefore important to plan well in advance if you or someone in your family is likely to need any significant dental procedures, such as root canal therapy or orthodontic work.
Health insurance funds sometimes offer to waive waiting periods to attract new customers. However, they rarely waive them for major dental procedures.
The Australian private health insurance system allows individuals or families to cover part of their healthcare costs by purchasing policies from health insurance funds. Private health insurance cover is usually divided into hospital cover, ambulance cover and general treatment cover.
Benefits for ancillary health services, including dental work, fall under general treatment cover. The extent of cover depends on the type of policy purchased.
Health funds in Australia are not all equal. In fact, they can be divided into several categories. The first is related to membership. Open membership funds are open to anyone, whereas restricted membership funds are only open to people who meet specific membership criteria. For example, they may only be for employees of certain companies or people with particular occupations.
Some funds are operated as not-for-profit organisations, with revenues used to cover operating expenses and pay benefits to members. Others are for-profit organisations, who aim to make money from premiums paid by members.
The sector also has its share of problems. The Private Health Insurance Ombudsman’s office received 3,706 complaints about private health insurance in 2019-20. The most significant benefit complaint issues revolved around extras/ancillary benefits. These complaints usually concerned disputes over the amount payable under ‘extras’ policies, including for dental treatment, along with insurers’ rules about benefit payments (such as minimum claim criteria).
Complaints over delays in benefit payments, as well as hospital and medical ‘gaps’ that led to out-of-pocket expenses, also comprised a significant proportion of complaints.
An independent comparison service can talk you through these issues when you’re considering private dental insurance.
As the Australian Dental Association point out, finding the best dental health insurance for you or your family can feel overwhelming. With more than 20,000 extras policies in the marketplace – all with different benefit levels, restrictions and exemptions – making a wise decision can be time-consuming and complex. Importantly, a good choice could potentially save you thousands.
Fair Health Care Alliance work with the Australian Dental Association and health practices Australia-wide to help Australians access their providers of choice (not just ‘preferred providers’ with health fund agreements) and receive fair benefits from their private health insurance funds.
We’ll help you compare health fund policies known for paying more back for health services and extras claims, irrespective of where you choose to have treatment. We particularly focus on identifying what’s most important for you in a health insurance policy, and on increasing your payouts for those services – often while also reducing your premiums.
Our experienced and helpful advisers will review your needs and help you compare health insurance policies, supporting you to choose one that’s right for your private hospital and extras needs – as an individual, couple or family.
We are skilled at helping you compare health insurance policies to your current one, highlighting the pros and cons transparently and honestly. We can also help you to switch funds.
or click here to start your journey to better dental health insurance.