Making the Most of Dental Health Insurance
Do you have dental health insurance? Many Australian families do.
By taking out a policy, you may be able to receive a rebate when you visit your local dentist. Some people may receive extras health cover through their work, whereas others may take extras coverage up independently. For many, having extras cover on their policy gives them a ‘safety net’ to help cover regular dental costs and any unforeseen major dental expenses.
Some health insurance extras expire and reset at the end of the financial year. Others reset on January 1 as a new year begins and others may reset at another date during the year. Either way, it sometimes happens that health insurance holders with dental extras cover approach the reset date with benefits still available to be claimed on dental extras.
In this article, your local Indooroopilly dentist, River City Dental, will be exploring a few ways that you can maximise your dental benefits with your health insurance provider to keep your teeth healthy, improve their appearance, and protect your overall health.
Firstly, what is a gap?
When you have health insurance cover, you will receive a rebate when you access certain services are your dentist Indooroopilly.
For example, if your health insurance fund covers 60 per cent of a $200 check up, $120 would be paid to the dentist by the health fund via HICAPS and this amount is deducted from your available annual allowance for that particular type of service (e.g. general dentistry).
The gap is the difference between your health fund rebate and the overall cost of the dental service you paid for that day at your Pullenvale dentist or Chelmer dentist. Continuing with the above example, your gap would be $80. The gap is the amount that you actually pay to the dentist. It refers to your out-of-pocket expenses.
Sometimes, your health cover (depending on your level of cover and your insurance provider) may cover the costs of your entire dental visit, allowing you to have a dental treatment done with ‘no gap’ – that is, no money out of pocket on the day.
You may find that with certain preventative dental treatments, you are fully covered by your health provider for a set number of treatments in a 12mth period eg. Two checkup and clean treatments. When looking into your policy, ask whether you receive a set % back as a rebate each visit or whether you can claim back 100% each visit until your limit is reached. It all depends on which provider you have chosen and the terms of your policy.
Discuss your coverage with your insurer and your dentist
Firstly, it is important to consider when you are taking up your health insurance policy what you would like covered. It is common for Australian insurance companies to offer a general dental option and a major dental and orthodontic option.
Different insurers will cover different aspects of dental treatment, but as a rule of thumb you may find that general dental includes services such as your 6-monthly dental check-up, fluoride treatment, scale and clean, X-rays, fillings, extractions and mouthguards.
The major dental option is included less often as standard but may be something to consider depending on your circumstances. This option may or may not include periodontal treatment, complex surgery, root canals, crowns and bridges, implants, and dentures.
There may also be an orthodontic option. Orthodontics is the branch of dentistry that deals with the alignment and positioning of dental and facial irregularities, helping to correct them through treatments such as braces and invisible aligners.
Some health insurers may also cover cosmetic dental treatments such as Zoom Teeth Whitening.
When you are arranging your appointments at your local Indooroopilly dentist or Brisbane dentist, it is important to check with your health insurer in advance what your insurance will cover you for, and how much your out of pocket expense will be.
Choose a policy that suits you
Everyone’s circumstances are different, but for those looking for health cover who have not already signed up, it may be worth assessing your priorities and investigating whether you are sufficiently covered for dental care.
Some people will find they feel most comfortable knowing they will receive a rebate even for a selection of non-general dental procedures. It is often possible to switch or expand your policy if you have already taken it up and find that it is not right for you.
Also keep in mind when selecting a policy, that there may be a waiting period which will prevent you from utilising your health insurance straight away at your local Taringa dentist, Indooroopilly dentist, emergency dentist, or other dentist near me.
Yoru individual circumstances need to be considered, but the fact there are waiting periods means that you should consider taking up dental insurance in advance of having noticeable dental issues, rather than waiting for issues to arise.
Waiting periods can differ in length. Some may be 2 to 6 months for general dental, whereas others (for example, major dental and orthodontics cover) may be 12 months or more. This is a way of stopping people who have just taken up health insurance from making large claims and then abandoning their insurance after the treatment is complete.
Develop a treatment plan with the help of your dentist
From an overall financial perspective, health insurance is most valuable if we use it. If we have a health insurance policy and we do not make the most of its benefits, it has little value, except for peace of mind.
Sometimes there is a combined annual cap for a range of services, but on other occasions those with insurance may find their annual limits are separate for different aspects of cover (e.g., Physiotherapy, dentistry, remedial message), so by ‘dipping in’ to one, you may not affect the amount available for the other type of service.
If towards the end of the benefit period, you find that you still have a lot of money remaining for a particular type of service before you reach your annual limit, see if your Indooroopilly dentist or Pullenvale dentist is happy to discuss how to maximise your cover.
Your dentist near me may be happy to help you develop a treatment plan, that ensures the cover you are paying for isn’t going to waste, but rather, that it helps to improve your oral health and contribute to your dental wellbeing.
Get to know your reset date and the details of your policy
Your insurer is likely to have policy documents available, either on their website or which they have emailed through to you at one point, that articulate the exact aspects of dentistry that your policy covers. These same documents are likely to also specify the reset date of your policy.
The more closely you understand your policy, the better you can take advantage of your dental cover for services such as your check-up and clean, X-rays, basic fillings, and other general dental.By maximising your benefits, you can ensure that overall, you are limiting the amount you spend at your local dentist.
It is worth noting that many health funds do not cover cosmetic procedures such as whitening, however, cosmetic procedures that have benefits for overall oral health/function may be potentially covered under your policy. For example, dental crowns may be covered under your health insurance policy. Dental crowns are a cap that is placed over a damaged tooth, and which restores the appearance of the tooth, but also improves chewing ability and protects the damaged tooth underneath.
Other aspects of cosmetic dentistry that your extras health insurance may cover include veneers, bridges, and dental implants.
If you need wisdom teeth surgery, health insurance may be helpful
Removal of wisdom teeth can often be performed at your local dentist in Indooroopilly, Taringa, Brisbane, or surrounding areas. It is often important to have emerging wisdom teeth removed to prevent the crowding of existing teeth, the risk of infection, and or discomfort.
The removal of wisdom teeth is associated with a number of different costs, and many will find that having health insurance will minimise these costs. Firstly, the examination of wisdom teeth may require an X-ray, which is often covered under ‘general dental’.The wisdom teeth removal procedure itself may be covered under ‘major dental’ health insurance policies. Talk with your dentist and your insurer to determine your level of coverage in these circumstances.
If you have your teeth (or your child or teenager’s wisdom teeth) removed in hospital by an oral surgeon, then hospital cover (which is usually distinct from extras cover) may be beneficial for limiting out of pocket expenses.
Plan your timing in advance to maximise your benefits
It may be beneficial to take a tactical approach to how you use your health insurance. Let’s use an example to demonstrate this point.
Imagine you are approaching the end of your reset period, and you need to have your check-up, but you also know that you need to have a non-urgent procedure performed, for example, to have a mouthguard developed for a sports team – even though the season isn’t on currently.
It may or may not be beneficial in such circumstances to have the check up and clean done on one side of the reset period, and to have the mouthguard made when your annual limits reset. That way, you may be able to prevent ‘maxing out’ on your benefits so that you have to pay more out of pocket to cover the cost of the mouthguard.
Not all dental treatments are completed in one visit. If there is a dental treatment that takes multiple visits and you happen to be near the end of your term, your dentist may be able to split the treatment across your benefit periods, allowing you to claim for both visits (if this is necessary, i.e., should you max out for the current period during your first visit).
Of course, if you are using your health insurance tactically like this, always balance up the disadvantages of delaying treatment. For example, if you have cavities, there may be risks associated with delaying your fillings. You may experience pain, and there may be opportunity for the tooth decay to become worse leading to more expensive treatment such as a root canal.
Your dentist can advise on the urgency of a given treatment, and help you to make informed decisions about how you use your dental health insurance extras cover at your Taringa dentist, Chelmer dentist, Brisbane dentist or Indooroopilly dentist.
Visiting the dentist more now may save money in the long term
Whether you have health insurance or have decided that you do not need it, the benefits of preventative dentistry are extensive. By undertaking your regular dental check-ups, your Indooroopilly dentist has the chance to keep your teeth in good condition, and to detect and treat any issues early before they become more advanced and require more costly treatments.
To arrange your six-monthly check up with a local dentist in the Indooroopilly area, you can contact River City Dental today on (07) 3667 9595 or firstname.lastname@example.org, or browse our website for more information at rivercitydental.com.au.