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?


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