Medicare : What Dental Services are covered in Medicare?

Child Dental Benefits Schedule is a government program covered by Medicare that its main aim is to provide dental coverage for children between the age of two and seventeen. The program was startedon 1st January 2014. More than 3.4 million eligible children across Australia benefit from this program each year. Eligible children are provided with up to $1000 in benefits for basic and preventive dental services. This program was meant to replace the Medicare Teen Dental Plan. For a child to be eligible, the family of the child must be receiving Family tax benefit part A or any other relevant government payment. Other relevant government payments include ABSTUDY, disability support pension, career payment, youth allowance, training scheme and double orphan pension among other payments. Basic dental services such as dental x-rays, check-up, extractions, filling, dental cleaning and scaling are included in this scheme.

If you are eligible for this program, you will receive a message from the Australian government either electronically or through a letter. The government continuously performs routine checks to determine if any new children are eligible. Most eligible children will be informed about their eligibility during the start of the year. Your Medicare dentist can also be able to let you know if you are eligible for the services. So, before receiving any services from the dentist, it is important first to confirm your eligibility. Also, it is good to call your dentist before visiting him to confirm your eligibility. The dentist will be able to confirm if your child is eligible by calling the Department of Human Service.

Is My Child who is Turning 18 or 2 During the Year Still Eligible?

Yes, a child will remain eligible for CDBS as long as he or she is between the age of 2 and 17 for a minimum of one day during that particular year.

How Does the $1000 Cap on Dental Services Work?
Children who are eligible for this program are entitled to $1000 in benefits to be used over a period of two years. The two year period starts on the calendar year and not from the first dental appointment date. The benefits are available for a period of two years meaning that any benefits that were not used in the first year can be carried forward to the second one. However, any benefits that have not been used by the end of the second year cannot be carried forward to the third year. Eligible children have the liberty of using all their benefit within the first year. However, in such a case, there will be no extra benefit that will be availed until two years are over. No further benefit will be available after the child has reached his or her $1000 limit under the program within the two year period.

The Child Dental Benefits Schedule provides benefit for a broad range of dental services. However, the benefit does not cover some complicated dental work such as orthodontics, cosmetic dentistry and surgical work. The child can only benefit from basic dental services as mentioned above such as filings, x-rays, root canal therapy and extractions. For a dental service to be covered by this program, it has to meet some certain criteria. First, the dental service must be clinically relevant. A clinically relevant service is the kind of service accepted by a dental professional to be necessary and appropriate to the patient. Dental services such as cosmetic work are not considered to be clinically relevant.

Also, when it comes to restorative Services under this program, only adhesive or metallic restoration can be claimed per tooth per day. This includes separate restorations that havebeen placed on the different tooth surface that was applied on that specific day. This means that if a patient chooses to have more than two restorative dental fillings on a different tooth, only one will be covered. Also, under CDBS, the dental sedation fee can only be claimed once per day. The program dictates that the dentist is only supposed to use nitrous oxide mixed with oxygen as sedation gas. This means that the benefit will not be covered if the dentist uses any other gas. The program also states that the patient can only undergo through sedation twice within a period of twelve months. This means that the program will not cover if one undergoes multiple dental works and require sedation for more than two times within twelve months.

Do I Need to Pay a Dentist After Receiving Dental Services Under CDBS?

At the day when you will be receiving dental services from your dentist, be sure to ask them if they offer bulk-billing services. If they don’t, it means that you will have to pay for the services then ask for a rebate later from the Department of Human Service. However, if the dentist offers bulk billing services, it means that you will not have to pay for any dental cost. Also, note that CDBS only covers for a limited range of dental treatment. You will be required to personally meet the cost of any dental service you receive the program does not cover that.

For personal claiming, the patient should obtain a receipt from the dentist bearing all the services he or she received including the cost of each service. The patient will use the receipt to claim for compensation from Medicare directly. The patient can do this by personally visiting the Medicare care centre with the itemised receipt or send it to the Department of Human Resource. Heor she can also claim for compensation electronically if his or her dentist doesn’t offer bulk-billing services. For an electronic claim to be valid, the patient must include details such as the name of the patient, the date when dental services were offered and the provider’s name and number. Other details include the type of services under CDBS that were offered and the cost charged for each service.

For you to avoid going through all this hustle, the best thing is to find a Medicare dentist who offers bulk-billing services. When you receive CDBS services under such a dentist, all you will have to do is provide your Medicare card after receiving the dental services. You will not be required to pay any out of pocket cost as long as you still have some balance in your CDBS Medicare account.

Can Private Insurance Be Used for Child Dental Services?
Patients who have a private insurance cover cannot claim dental benefits from both the private insurance and CDBS for the same dental services offered. Also, patients cannot use their private insurance cover to top up for service received under CDBS. However, a patient has the liberty to use a private insurance cover to receive services that are not provided under the CDBS. However, this services must be billed differently.

Straight teeth and a beautiful smile is not only meant for kids; adults too need to have an attractive smile. Now that Medicare has no coverage for dental services offered to adults, it is advisable to find an affordable dental insurance cover to meet your dental needs. I know finding a good insurance company that offers favourable plans can be an uphill task but don’t worry, there is still quite a number out there.

Unlike medical insurance, dental insurance is not taken as important by most people up until they find themselves having dental issues and the dental treatment cost is out of range. Now that most of the insurance companies are offering dental insurance plans, you should take a dental insurance plan to keep in check your dental costs. Dental treatments can be very expensive and having dental discount plans, and dental insurance can be of real help. Dental insurance plans are pre-payment of fees for future dental treatment procedures. Dental insurance plans have many clauses, therefore, one is required to be very cautious when choosing the right plan for their needs. Here are various aspects to consider when choosing a dental insurance plan:

The waiting period for dental insurance

You may find some insurance companies which have a waiting period of up to 12 months for them to start your coverage. This can be a waste of time in case you need urgent dental care. Low-priced insurance policies often have long waiting periods,so one is required to pay for their treatment costs out of their pockets. Therefore, it is advisable to choose a dental insurance plan that is most suitable for your needs. It is best to keep your dentist updated and enquire from him on the best dental insurance plan for your treatment.

Examine the list of dentists in the network

Unlike the indemnity insurance plans, the PPO and HMO insurance plans do not offer you with the freedom of choosing your preferred dentists. In case you have a dentist that you are comfortable with and prefer, find out which discount plans he accepts. If at all you do not mind trying out a new dentist, then an HMO and PPO can be good for you.

Dental insurance plans for respective treatment procedures

The dental insurance companies always ensure that they get most out of their insurance plans. Therefore, it is best to choose the most suitable plan for you carefully. Most of these insurance plans do not cover for the teeth that were lost before you took up the plan. So, if you happen to lose a tooth near the one you lost initially, then the insurance company won’t cover the cost of the bridge installed in the previously lost tooth before you took the plan. Some other dental insurance plans do not offer coverage for implants; others do not cover for lingual braces and invisible braces. Therefore, one must be specific on the insurance plan that one needs that will cover his specific needs.

Find out if you can get group coverage

Most of the people covered by dental insurance plans have benefits through their employer or group coverage programs such as Affordable Care Act. Such plans are quite affordable and may have better benefits than those of individual insurance. It is always good to scrutinize the details of a plan before purchasing it, to decide whether their premiums are worth your money.

Check into individual policies
Individual policies are often more expensive with more limited benefits than group policies. They also have a longer waiting period for major treatments than group policies. If you are thinking of purchasing a plan because you urgently need an implant or a set of dentures, this may not work for you. This is because insurers are more aware of this trick. Therefore they institute a waiting period of possibly a year for you to start enjoying your benefits. It is best to compare options while shopping for a plan. You may get the policy details and price quotes from the insurance company website or talk to a person who is well knowledgeable about the plans.

Everyone desires to have a great smile; therefore, proper dental care is important. Poor oral hygiene leads to several oral and overall body issues in your coming days.Some oral problems associated with poor oral hygiene include gum disease, cavities and tooth decay. It is also linked to some general health complications such as stroke, heart disease and diabetes.Routine dental check-ups and professional cleanings can prevent you from having such health problems as well as provide you with good oral hygiene. Here are tips to help you keep your oral health at its best:

Limit intake of alcohol, tobacco use and sodas
For one, tobacco is something you should completely shun away from. Shunning away from tobacco can save you from many periodontal diseases such as oral cancer. Additionally, the stuff that you would use to hide that tobacco smell such as coffee, tea and sweets will end up worsening the damage already done by tobacco. Also, you should limit your alcohol and soda consumption. Such drinks contain phosphorous, which is an important nutrient for healthy teeth. However, an excess of anything is harmful to your health,and this applies to phosphorous too. Excessive consumption of phosphorous diminishes the level of calcium in your body resulting in oral health issues such as dental cavities and gum infections. Instead, go for drinks that strengthen your tooth enamel and water to hydrate yourself. In case you really must take sodas or alcohol, ensure that you use a straw to minimise direct exposure to your teeth.

Proper Brushing

Proper brushing is the easiest way of keeping your mouth and teeth clean. To efficiently brush your teeth, always position your toothbrush at an angle of 45 degrees near your gum line. Ensure that both your tooth surface and the gum line is in contact with the bristles. Gently brush the teeth and gums outer side in an up and down, back and forth motion to avoid injuring your gums. When cleaning your inner side of your gums and teeth, once again place your brush at a 45 degree and repeat the same motion. Finally, clean the roof of your mouth and your tongue surface to get rid of bacteria which lead to bad breath.

Ensure that your diet is teeth-friendly

For most adults, if not all, their main reason for eating something is that they love its taste. However, we should always consider the kind of foods and drink we intake. Vegetable and foods such as chicken, cheese, nuts and fruits are teeth-friendly. One extra thing to note about cheese is that it increases your saliva production which helps in neutralising acids in the mouth.

Get regular calcium and other vitamins that are good for your body

Presence of calcium in your body is very important; it helps in building healthy teeth and strong bones. Dairy products such as milk, cheese and nuts are a great source of calcium; you can get your regular intake from them. For your body to absorb calcium, it requires vitamin D. Therefore, ensure that you regularly go outside every day and get some sunlight. Vitamin B complex also plays a role in your teeth by protecting the gums and teeth from bleeding and cracking.

Flossing

Flossing can be a task and often forgotten after brushing your teeth. Yet, flossing is very important as it helps to remove food remains and other harmful substances which cannot be cleaned by regular brushing. Flossing helps you to reach deep between your teeth where mouthwash cannot rinse or toothbrush clean. It is recommended to floss your teeth at least once a day.

Look at the big picture

Every adult understands the benefits of taking good care of their teeth to prevent toothaches, maintaining good looks and keeping dental bills at bay. However, most of the adults do not understand how important dental health is to their overall health picture. Dental issues can lead to systemic infections, diabetes, heart disease, inability to chew and speak properly and other life-threatening diseases. Also, crowded or crooked teeth can cause gum disease which will eventually result in tooth loss. Properly aligned and straight teeth are no longer just for the appearance.

Block blows to teeth

Recreational activities and sports help in building a healthy body, but they may also be a great threat to your teeth. Ensure you ask your dentist to make you a customised mouth guard to protect you from injuries.

Replace your toothbrush regularly

It is recommended that you replace your toothbrush immediately after a disease or after every three months. This ensures that you are not re-infected by the disease,and your teeth get to be properly cleaned.

Do not ignore aches and pains

If you experience any teeth sensitivity, jaw pain or a toothache, do not ignore and delay visiting a dentist. There might be an underlying cause which can be identified by your dentist who will help prevent the problem from worsening.

Keep your dental care equipment clean

Always rinse off your toothbrush and oral irrigator with clean water after using them. Keep your toothbrush in an upright position in the medicine cabinet. Avoid covering your toothbrush as it may lead to bacteria and mould growth. Also, drain all the remaining water in your oral irrigator and allow it to dry to avoid bacteria build up.

A regular visit to the dentist

Ensure you see your dentist at least twice a year to have your oral hygiene treatment done. During these visits, comprehensive exams of your dental health are taken to detect and prevent any future dental problems.

There you have it; all you need to know about Medicare dental services and how to choose insurance dental coverage for adults. If you have received a confirmation from the government that your child is eligible and has been covered by CDBS, all you have to do is provide a Medicare card to your dentist during your next dental appointment. If your dentist offers bulk billing services, you will not have to pay any out-of-pocket cost so long as the service offered is covered under CDBS. Medicare has currently no insurance plan for adults. However, it’s not all lost; there are quite a number of private insurance plans that can cover your dental needs. All you need to do is find an affordable plan and visit a dentist who accepts to offer services under insurance plans.