Ask LH: Will Health Insurance Pay For My Dentist?

Ask LH: Will Health Insurance Pay For My Dentist?

Dear Lifehacker, I’m an apprentice so been a little short on funds for the last four years. I have a couple of tooth cavities I would like to fix soon but am not sure how to go about it. Is it best to just go to a private dentist and get it done there or am I better off signing up for private health insurance? Thanks, Cavity Guy

Dental work picture from Shutterstock

Dear CG

It depends on how bad the cavities are. As a general rule, health insurance won’t cover pre-existing conditions or ‘PECs’ without making you jump through a few hoops first. At the very least, you can expect to be slapped with a 12 month waiting period before your benefits for hospital treatment kick in.

This is standard practice under the Private Health Insurance Act 2007 and covers most dental procedures including tooth extraction, root therapy, dentures and other forms of oral surgery.

If you need to undergo oral surgery, there are additional caveats to be mindful of. Here’s what the Australian Private Health Insurance Ombudsman has to say about oral surgery on its website:

“When claiming health fund benefits for surgical tooth extractions, it is important to be aware that in most cases, the amount of your benefit will be determined on the basis of the provider of the service, i.e. whether it is a general dentist or an oral surgery specialist; and whether you have the procedure in the operator’s chair or you are admitted to hospital as an in-patient.”

The below table indicates whether you can expect to receive a benefit towards your oral surgery procedure, based on the type of cover you have.

Credit: Private Health Insurance Ombudsman  

If your teeth issues are causing serious discomfort you might need to bite the bullet and arrange a private appointment with a dentist. Unfortunately, Medicare only covers dental work for children aged between two and 17 years of age which means you’ll need to fit the bill yourself.

That said, you might be able to claim up to 20 per cent of your expenses back at tax time depending on your family status, yearly income and the size of your medical bills. For more information, head to the Australian Taxation Office’s website.

Naturally, if you do decide to sign up to a health fund, be sure to check all the T&Cs with a fine-tooth comb! We’d also like to hear from readers who have dental cover — share your opinion with CG in the comments section below.

See also: Improve Your Dental Health This Weekend | Am I Brushing My Teeth Correctly? | Why You Should Never Skip Flossing Your Teeth | Australian Health Insurance: A Big Rip-Off?

Cheers Lifehacker

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  • Hospital cover isn’t going to do anything for dental. Most health funds usually have a 3 or 6 month waiting period for extras for new customers.

  • Consider looking for teaching clinics, where experienced final-year dentistry students do the work while being supervised by an experienced dentist. For example, the Oral Health Centre at the University of Western Australia:

    If you are still an apprentice, you might fall under the “low income” eligibility.

  • You’ll need Extras Cover which you can get without taking up Hospital Cover. You’ll then have to sit out the waiting period before you can claim. You may also need to check if your dentist is on the “approved list” of providers for your chosen PHI company.

    After that, you’re good to go, but you need to be aware that, the Extras cover will have an overall $ limit that you can claim and will only pay a percentage of the bill, so you’ll likely still be out of pocket.

  • I had top dental cover, then last year I had to have a crown fixed (or something like that, I forget the details) and it cost $4000, of which I got back $400. I now no longer bother with the extra cover as the premiums simply don’t justify it.

    If my dentist had billed even one squirt of rinse water as homeopathy I might have gotten back $500.

    • Good to know, I am in a similar situation right now, old rootcanal filling cracked on the inside.
      Fixing it will cost $5000 aparently with success rate of below 80%. Even getting it pulled costs you $150, but $500 if THEY do it wrong and crumble it. Great to know I will almost get nothing back with the extras premium.

      If it was $5000 and I got back almost half. Fine..
      But seriously! Why is dental work so expensive again?

      • When I cancelled the extra cover, Medibank warned me I’d lose obstetrics too. Gee.

    • I found this when I was looking at insurers … I found dentistry just wasn’t worth paying for cover.

    • Yeah, you really need dentist + optical to get anywhere close break-even point on extras. 🙁 Maybe a couple physio trips, but the rest is mostly pointless.

  • Google Noble Dentist and you will find another tool that can compliment health insurance rebates. It’s basically a members coop for dentists and patients.

    A one off membership fee gives instant and unlimited access to a reasonable discount on most dental services. Yes you pay when you go but you pay much less. Plus if as an example you get 50% back on your insurance, think how much better 50% off a 20% discounted service through the dental pkan sounds.

    • Noble Dentist are often not 20% below a dentists fees. Some work is slightly lower, some the same, some higher. I had to ask my dentist to not charge the noble dentist rate (was a member for 2 years) as it was higher than there pricing. In saying that, it was good to know the price before walking in the door.

      • Good to know. I had a bit of routine gum work and then just regular cleanings that worked out cheaper and on average approx 20% lower. Next time I member up I will make sure to check on which is cheaper. K

  • Check out the thousands of the dental tourism discussion threads. Make a call whether this is a viable option for >$2k or so jobs. For example, dental crowns are $200USD reportedly in Ho Chi Minh. Look for dental technicians with overseas training and a long, long list of references.

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