Taking out dental insurance to cover your oral health needs

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You can avoid numerous oral health complications through proper preventative oral care and hygiene – but not all of them.

If you are over 40, the possibility that you’ll need complex dental work increases dramatically. However, age isn’t the only risk factor for experiencing major oral health issues in life. Even young, healthy school children may require extensive dental work if they need braces or experience accidental oral injury.

When you and your family’s oral health take a turn for the worst, it pays to be prepared with the right dental cover in place – if you want to avoid paying unexpected dental costs at full price for complex dental treatment.

How do I purchase dental insurance?

In Australia, dental insurance only is usually not available. Dental cover, along with physio and optical, usually come under an “extras cover” as part of a private health insurance plan purchased from a health insurance provider (a.k.a. a health fund), such as Medibank Private, HCF or Bupa.

Hospital cover, without extras cover, can give you access to in-patient dental procedures in a hospital emergency department, including oral injury, oral infection and wisdom tooth removal.

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What types of dental cover are there?

There are a number of levels of dental cover, but in general there are two classes:

  • General dental covers you for a range of preventative dental treatments that will maintain your oral health, and help you prevent more serious oral health issues. These treatments can include oral examinations, consultations, scale clean & polish, plaque removal, minor fillings, fluoride treatment, fissure sealants and X-rays.
  • Major dental covers you for more complex dental treatment, such as crowns, bridges, braces (orthodontics), treatment for gum disease, root canals, emergency dental and oral surgery (e.g. wisdom tooth removal & other extractions), as well as dentures. Dental implant treatment is only partially covered at best by the most costly, premium health insurance packages.

Cosmetic dental treatment is not covered by health funds except as part of a dental restoration procedure.

Read a health fund’s policy carefully

All health funds offer their own unique set of general and major dental benefits, so it is important to check with a health fund’s policy brochure carefully. Look for the specific benefits that you may need to access, at each level of cover. Don’t forget the fine print!

What type of dental cover do I need?

To work out what type of cover you need, you have to consider your current and future personal situation.

Consider this checklist of factors to help plan & choose the right dental cover for your oral health needs:

  • Are you single, a couple or a family?
  • What is your age group?
  • What is your current oral health status?
  • What is your personal and family oral health history, and can it impact on your future oral health?
  • Do you or your family members have a pre-existing oral condition that may require future treatment?
  • Do you have a child that will need braces?
  • Do you or your family participate in contact sports or high-risk physical activities?
  • Is your family eligible for the Child Dental Benefits Schedule (CDBS)? (The CDBS provides up to $1000 in general dental benefits.)
  • Will you need dentures?
  • What are your finances like?
  • What level of cover can you afford?
  • Waiting periods can range from 2 to 12 months. How long is the waiting period for the treatment you need cover for?
  • How long can you wait for treatment?
  • Benefit limits are what your health fund will cover for any specific dental procedure. Do you prefer to be covered with a percentage limit (e.g. 80%) or a set dollar amount benefit limit?
  • Are you prepared to pay the out-of-pocket (gap) expenses that your health won’t cover?
  • Do you prefer gap-free preventative general dental treatment and other “freebies”?
  • Annual limits – Will a policy’s annual limits cover the cost of the dental treatment you may need?
  • Is your local private dentist a preferred provider for the health funds that you are considering?
  • Do you prefer priority dental appointments?

Young adult singles and couples

If you are a single or couple aged in your 20s or 30s in good oral health, a good cover option is general dental. You don’t need to be too concerned about serious oral health issues just yet, except for those involved in activities with a high risk of accidental oral injury and/or trauma. Major dental cover would probably be a waste of money.

Families and adults aged 40+

For families and adults over 40, with whom the possibility of a complex dental procedure or treatment is anticipated, a higher and more expensive level of dental cover may be more suitable. In the long term, you can save a lot of money on potentially costly dental treatment, despite the higher premium.

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