Dental insurance can be useful, but it’s important to understand what does dental insurance cover in your policy. If you’re paying for dental cover as part of your health insurance, it makes sense to make use of your benefits each year.
Most policies will not cover elective or cosmetic treatments. Where insurance can help is with unexpected dental needs, like if you chip or lose a tooth, or when you require treatment such as a filling. Many policies also provide some cover for ongoing preventive care, including routine check-ups and professional cleaning.
Check your dental cover
As health insurance policies all differ, it’s important to read the fine print on your dental cover so that you are clear:
- What kind of procedures your policy covers: If you only have a basic premium it may not include insurance rebates for treatments such as orthodontic dental work or hospital visits for removal of wisdom teeth.
- If your cover includes cosmetic procedures: Many policies don’t include cosmetic procedures such as veneers, implants, teeth whitening, inlays and onlays.
- Whether you can add on coverage. This then allows you to claim for a wider number of dental treatments and procedures.
- Whether you will pay a gap fee: Depending on your insurance policy and the dental treatment you undergo, you may receive a rebate of around 50% to 100% of the total cost. Make sure you are clear on what amount of gap fee you have to pay so you don’t get caught out unable to cover the shortfall.
- Whether there is a waiting period: For most health insurance packages, you need to wait 12 months before you can claim for some procedures and you may not be covered for treatments for a pre-existing condition.
- If your insurer caps claim amounts: This means that you can only receive a certain amount of money back for particular types of procedures per year.
Insurance cosmetic procedures
Most dental insurance policies do not cover procedures classed as ‘cosmetic’. Even when a procedure is part of essential dental care, it may still be considered cosmetic. For example, a cracked tooth may require a veneer to match the appearance of the surrounding teeth. While necessary for function and aesthetics, the veneer could still be categorised as cosmetic, meaning it may not be covered by your insurance.
At The Dental Room, we provide our clients with the relevant health insurance item numbers so they can check with their provider before treatment. This helps ensure there are no surprises and allows you to plan for any out-of-pocket costs.
Alternatives to dental insurance
In cases where clients are not covered for dental procedures or treatments, we offer a free payment plan to help them with their cash flow and dental budget.
Alternatively, some people may save up before electing certain procedures, such as cosmetic dentistry. This isn’t a bad option, although it does require a fair bit of discipline when it comes to saving.
NEXT: Medicare and Dentistry
About Dr Shawn Rama
Dr Shawn Rama is the Principal Dentist and Founder of The Dental Room, with more than 20 years of experience in general and aesthetic dentistry. He graduated from the University of Melbourne in 2003 and has undertaken further training in aesthetic dentistry, complex restorative dentistry and dental implants. Dr Shawn is also an accredited Invisalign® Platinum Provider and a member of the Australian Dental Association. He founded The Dental Room in Balwyn North in 2016, creating a boutique practice centred around personalised, considered dental care.
