The Medicare Dental coverage can be a confusing process, especially when you are not sure what treatments are covered by the rebates or how to check whether you are covered or not. It is important to understand your Medicare dental eligibility so that you can effectively manage dental healthcare costs and ensure that you are getting the best benefits that are available to you.

Medicare dental coverage in Australia is very limited when compared to general medical coverage, and there are some requirements and limitations that patients need to know. While the Australian government has dental benefits under various schemes, it is important to note that Medicare itself only provides one dental benefit.

Does Medicare pay for dental care?

The answer is mostly no. Medicare dental coverage is extremely limited and only covers one program, the Child Dental Benefits Schedule (CDBS). Most dental treatments for adults are not covered by Medicare’s Benefits Schedule (MBS). However, medical procedures related to the dental practice that are performed in a hospital setting as part of medical treatment may be covered under Medicare’s medical benefits, but are not dental benefits.

Understanding Eligibility for Medicare Dental

Medicare dental eligibility in Australia is easy but restricted. The only dental benefit that Medicare provides is:

Child Dental Benefits Schedule (CDBS): This scheme provides eligible children aged 2 to 17 years old with up to $1,000 in benefits over a two-year’ period for basic dental services.

Children must meet the following criteria to be eligible for CDBS:

Be eligible for Medicare
Be aged between 2 and 17 years
Be claiming Family Tax Benefit Part A or be entitled to other specific benefits.

What Does Medicare Insurance Entail Dental?

Child Dental Benefits Schedule (CDBS): Basic dental treatment administered to children who are eligible such as examination, cleaning, fissure sealants, fillings, root canal treatment and tooth extraction. It is the only dental service covered by Medicare.

Important Note: Hospital dental services, emergency dental services in hospitals and specialist oral surgery may be covered under Medicare medical benefits (not dental benefits) if they are medically necessary and provided in a hospital setting.

Reviewing Your Medicare Dental Coverage

To find out if you are currently eligible for Medicare dental coverage:

Medicare Online Account: myGov allows you to check your Medicare online account to see your CDBS eligibility and remaining benefits.
Dental Provider: A lot of dental offices can check your CDBS eligibility and send your bill to Medicare.
Medicare Phone Line: Call Medicare at 132 011 to verify the eligibility of your child and the balance of his/her benefits in the CDBS.

Alternative Dental Insurance Providers

Public Dental Insurance Schemes

Each state and territory has public dental services which offer subsidised dental care to eligible patients (typically concession card holders). These programs have:

Long waiting lists for non-emergency care
Eligibility for income and concession cards
Different services depending on where you live

Private Health Insurance

Many Australians take out private health insurance with dental cover (extras cover) to have access to:

Major dental treatments
Shorter waiting times
Regular dental care such as check-ups and cleanings
Choice of provider

Dental Insurance for Seniors

Seniors can avail themselves of public dental programs through their state health department if they have the relevant concession cards, or through private extras cover of health insurance.

Other Government Dental Schemes

Other government programs not included in Medicare are:

State Public Dental Services: Open to concession card holders.
Department of Veterans’ Affairs (DVA): Dental services for eligible veterans
Indigenous Dental Programs: Specialised services for Aboriginal and Torres Strait Islander communities

Ways to Get the Most Out of Your Benefits

How to maximize dental coverage:

For families: Make sure your children are signed up for CDBS and use the full $1,000 benefit over two years.
Take into account extras cover of private health insurance on comprehensive adult dental cover.
Know about the waiting on the public programs and personal insurance.
Take care of the oral health to prevent expensive emergency care.

Conclusion

The level of dental coverage in Medicare in Australia is minimal and is restricted to children under CDBS program. Adults need to cover dental using state public dental programs (where they are eligible) or private health insurance. This limitation is important to understand when planning your dental healthcare expenses.

For those in the Carrum Downs area who require professional dental services and advice on dental benefits, the Carrum Downs Dental Group offers a full range of dental services. Our team of experts will assist you in the CDBS of eligible children, assist in applying to the public dental programs, and provide information on the options of the private health insurance to make sure that you receive the most affordable dental care in your specific situation.

Knowing the constraints of Medicare dental coverage and considering other alternatives, you can prepare dental costs and make sure you get the required dental treatment at the time when you need it the most.

How to Check If Your Dental Treatment Is Covered by Medicare