03 8845 5400
info@dentalprices.com.au
Medicare Rebates
Medicare typically does not cover dental costs. Medicare does offer a rebate towards the anaesthetic component of sleep dentistry costs. For more information click here. From time to time there are schemes introduced by the government to offset against dental costs, and we would typically be enrolled in any such schemes to ensure our patients receive their maximum entitlements.
Tax Rebates
Under the Medical Expenses Offsets category, individuals may claim tax rebates for out of pocket medical and dental expenses incurred minus any refunds received from Medicare or a private health fund. Please discuss your potential entitlement with your accountant. Eligible families or individuals can claim a tax offset of 20% for every dollar paid over $2,000 [OR 10% for anything over $5,000 for individual with an individual income of approx. $80,000+]. For elegible taxpayers, there is no upper limit on the amount you can claim. For more information about tax rebates on medical expenses visit the ATO website.
Health Care Fund Rebates
If you are a member of a health care fund that offers dental rebates, it is possible that your fund may cover part of your procedure to offset dental costs. The amount you receive depends on:
At Centre for Aesthetic & Implant Dentistry we have HICAPS facilities for on-the-spot claims.
Policies, inclusions and cover limits vary from fund to fund and patients need to check directly with the fund to ascertain their level of cover when comparing health funds or to determine their own rebates for any particular treatment.
Annual rebate limits for MAJOR DENTAL costs
Cosmetic Dentistry, Dental Implants, Oral Surgery, and many other procedures that are associated with moderate-to-high dental prices fall under what is commonly referred to as Major Dental. Apart from cosmetic dentistry, which is largely elective, many such procedures are often required following an emergency, such as trauma, infection, cracked tooth or the loss of a tooth requiring replacement. In such circumstances, dental cost exposure can be significant and unexpected.
The need for these procedures also increases over time as the teeth become more compromised due to large fillings, root canal treatment or wear. Thus adequate cover for MAJOR DENTAL is important so as to help offset the higher dental prices associated with such treatment, which is often also unexpected.
ITEM LIMITS: Most health funds pay for particular procedure only up to what they prescribe as a maximum amount. This is known as an Item Limit. It is important that the item limit is sufficient for more pricy treatment like crowns or implants, or for more frequent treatments such as fillings. When choosing a fund you should compare the limits for some popular treatments based on the item numbers provided in the guide below.
ANNUAL LIMITS FOR MAJOR DENTAL: Most health funds have an Annual Limit for Major Dental procedures. This means that you may only get a rebate for one or two major dental items per year, and no rebate for any other major dental work as may be required. It is important to know the major dental limit when comparing funds to ensure that this is adequate. Annual limits vary significantly from one health care fund to another, and depending on individual policies, and typically average anywhere from $600 to $2100 per annum.
LIFETIME & FAMILY LIMITS: Certain procedures, such as orthodontic treatment, may additionally have a lifetime limit of cover.
Rebates and Item Limits against GENERAL DENTAL prices
Most policies have no limit on General procedures, such as fillings, but dental prices for these are typically low for the average person. Also, with regular maintenance and preventative dentistry the need for fillings and general dentistry reduces over time, whereas the need for treatment that falls under MAJOR DENTAL often increases.
Preferred Providers
Certain Funds have what they call ‘Preferred Providers’ or similar. The term ‘Preferred’ may imply that the providers were chosen based on merit, whereas typically this is not the case. In most cases these are dentists who have chosen to enter into an agreement with the health fund and are often required to provide certain treatments for a prescribed fee.
Premiums or rebates may appear more attractive with a preferred provider scheme, but patient may only choose from the providers who are enrolled in these schemes in order to receive the prescribed benefits. Other means of attracting patients into preferred provider schemes include offering free check-ups and scale and clean. However the additional value of these offers is often less than one month’s premium. In addition, the apparently reduced dental costs often only apply to certain specific treatments.
All such restrictions and limitations may come at an altogether different cost. The pitfall is that when a fund dictates what fees must be charged there could be a need for dentists to reduce the time spent on treatment or to use inferior materials or laboratories, which may ultimately lead to a compromise in service or quality. It is important to have the freedom to choose your dentist based on merit or recommendation, not as may be dictated by your fund.
Most dentists and specialists in Australia have chosen not to participate in a ‘Preferred Provider’ scheme due to the concerns about the pitfalls that may affect the standard of care. Thus, when choosing a health fund it is important to give yourself the power of who to choose for your treatment and to avoid having a policy that is based largely on a preferred provider scheme.
GUIDE TO CHOOSING A HEALTH FUND
Patients often ask us which fund is best. There are many factors surrounding fund policies as well as patients individual circumstances. The guide below represents our opinion based on our own experience and patients feedbacks. Patients should do their own research about dental prices and providers so as to make their own opinion and determine what is best for them.
GENERAL DENTAL
✓ No annual limit
✓ Item limit should be sufficient. Compare the rebates on the following common general item numbers:
Item no. 532 (three surface composite filling; CAID fee approx. $150)
Item no. 311 (extraction; CAID fee approx. $180)
Item no. 419 (emergency root canal dressing; CAID fee approx. $200)
MAJOR DENTAL
✓ Item limit should be sufficient. Compare the rebates on the following common general item numbers:
Item no. 615 (PFM Crown; CAID fee approx. $2,000)
Item no. 688 (Dental Implant; CAID fee approx. $2,290)
✓ Annual limit should be sufficient. Compare the limit on Major Dental between the funds.
OTHER COVER
✓ Orthodontic cover is recommended for a family with kids. The more kids there are the higher the likelihood that one or more could benefit from orthodontic treatment, or if there is family history of crowding or crooked teeth. Otherwise if there is an option to exclude orthodontic cover and reduce the premiums, then this is could be preferred
ACCUMULATED BONUSES
✓ Some funds provide you with accumulated bonuses based on your claims history. This is certainly a positive and an advantage for patients as it may provide additional cover for treatment that may come unexpectedly.
PREFERRED PROVIDER SCHEME
✕ AVOID policies that are based on a preferred provider scheme due to the abovementioned pitfalls.
COMPETITIVE PREMIUMS
✓ Once all the above factors have been considered and compared, and assuming near equality with all the above factors, the policy with most competitive premium would generally make financial sense.
Form more information about dental prices please call us on 03 8845 5400 or email us today.