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Does Health Insurance Cover Orthodontics in Australia?

July 15, 2024
Does Health Insurance Cover Orthodontics in Australia?

Orthodontic treatment is often a huge decision, both medically and financially. But it can sometimes be confusing to work out if your orthodontic treatment is covered by private health insurance.

That’s why we are going to do a deep dive into all things orthodontic private health insurance, so you can understand what you’re entitled to.

Does private health insurance cover orthodontics in Australia?

While orthodontics is not covered under Medicare, you might be covered under private health insurance, depending on the details of your policy.

If you have ‘extras cover’ on your health insurance, you may be entitled to claim a portion of the cost of braces back from your health fund.

As there is no ‘one size fits all’ standard when it comes to coverage, it depends on your health fund and your level of extras cover, so it’s important to check with your private fund prior to starting treatment.

Orthodontic treatment, such as braces, generally isn’t covered by basic extras cover, so you’ll usually need a higher level of cover to receive a rebate. Orthodontic rebates from private health insurance range from a few hundred dollars to over $2,500 – so it pays to do your research.

If you don’t currently have any cover, you’ll need to weigh up your options to determine whether it will be more cost-effective to commence with or without private health insurance. Keep in mind, most private health funds require a 12-month waiting period for orthodontic treatment so you’ll need to think ahead if you might need it.

What type of private health insurance do you need for orthodontic treatment?

Orthodontic treatment may be covered within the extras policies of some insurance providers. While orthodontics will generally fall under the umbrella of dentistry, it is not considered to be general dental care (e.g. regular dental check-ups, cleaning and simple restorations) and may not even be included under major dental care (often classified as oral surgery, root canals or crowns). It’s vital that you check with your own private health insurance policy to see what is included with your individual plan.

How does orthodontic insurance work?

Orthodontic insurance works by allowing customers to cover some of the costs of orthodontic treatment. Depending on your fund and level of coverage, you may claim money back on certain types of treatment or for a specific number of appointments. There is generally a limit for how much can be claimed per person, per year, and often a “lifetime” limit.

How do you claim for orthodontic treatment?

Claiming for orthodontic treatment is not much different to claiming for other extras you may be covered for, though it will differ slightly between providers. Firstly, you serve your 12-month waiting period, then you complete an ‘orthodontic treatment plan’ – a crucial step as you will need this to claim.

After the plan is completed and you make your first orthodontic payment, retain your receipts, and ensure you have all the necessary details on them to make a claim. Such details will include a patient’s and orthodontist’s name, the date and amount paid, and the specific dental item numbers which reflect the specific procedures provided. This paperwork can then be submitted to claim. You may also be able to claim your rebate on the spot at your orthodontist’s office depending on your payment plan and if the practice has a HICAPS facility.

What are the limits applied for orthodontic insurance?

There are two primary limits set to insurance that covers orthodontics, which people should investigate before choosing a policy:

  1. Lifetime limit: The maximum amount that can be claimed during a lifetime.
  2. Annual limit: The maximum amount that can be claimed during a year.

What is the waiting period for orthodontic insurance?

A waiting period is a mandatory membership period to an insurer, where no benefit is payable. Orthodontics is covered under the extras in insurance policies. These extras often have 12-month waiting periods before a rebate can be claimed if you are taking out a new private health insurance policy. It is best to ask your own private health insurance company for their specific requirements.

How to choose the best private health insurance for orthodontics

Choosing the best private health insurance for orthodontics requires some research. When comparing online, it is important to look at if the policy you are looking at has lifetime or annual limits (a maximum total benefit you can claim in a lifetime or a year respectively). It is also worth looking at what you will be paying back in premiums over the life of the treatment. To make it worthwhile, you may want to claim for optical and other extras too. Also important to note is a policy’s percentage back price, which can be calculated online, through an insurance rebate calculator.

Health funds that cover orthodontics

This is a non-exhaustive list of Australian health insurers which provide some orthodontic cover:

  • Frank health insurance
  • Bupa
  • HBF
  • Medibank
  • AHM
  • Qantas Insurance
  • HCF
  • Peoplecare

How much does it cost to get braces without insurance?

Without an initial consultation, it is near impossible to determine the full cost of braces with or without insurance. This is because the cost of orthodontics depends on several factors including the duration and complexity of treatment and the type of treatment you choose. That said, here is a guide for what you can expect to pay for a full course of orthodontic treatment in Australia:

Metal braces (traditional braces): $6,000–$10,000

Ceramic braces: $6,500–$10,500

Lingual braces: $9,500–$15,000

Clear aligners: $6,500–$11000

* Note these prices are typically for a 15-to-18-month treatment period that not only straightens teeth but helps to correctly align the jaw as well. The fee generally includes the cost of regular orthodontic adjustment appointments, along with the post-treatment care and monitoring.

Are there government programs for braces in Australia?

There are no specific government programs in Australia that subsidise the cost of getting braces. The Australian Government’s Child Dental Benefits Schedule (CDBS) helps for 2 to17-year-olds to access a range of dental services and procedures for free. However, benefits for orthodontic treatment such as braces are not covered under the CDBS.

If your child has a cleft or craniofacial condition, then some proportion of the orthodontic treatment provided may be covered under Medicare, which can help parents of children with a cleft or craniofacial condition. Additional paperwork will need to be completed to assess the patient’s eligibility.

The Australian Society of Orthodontist operates a charitable organisation called Give A Smile, where orthodontists around the country volunteer to help under privileged children access safe and reliable orthodontic care.

Want to learn more?

Speaking to an orthodontist can help you to understand the cost, duration and potential future requirements of orthodontic treatment for your family so that you can be better prepared for the future. Use our Finder Tool to locate an orthodontist near you.

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