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Health Insurance For Orthodontics

Name: Health Insurance For Orthodontics
Creator: Savvy
Published: 2023-03-02T12:21:56+10:30

 Compare health insurance policies which cover orthodontics here with Savvy.

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Written by , updated on July 26th, 2023

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If you’re wanting to transform your smile or help your children grow up with straight teeth, you may be wondering where to find the best private health insurance for your needs to cover orthodontics. With hundreds of health policies available in Australia to choose from, the choice can seem overwhelming.

At Savvy, we help you compare health insurance policies from some of Australia’s leading insurers, so you have the information you need to make an informed choice. Getting free quotes is a quick and simple process, so you can compare health policies side-by-side. You can also get assistance from a specialist to guide you through the process of getting your health insurance straightened out. Start comparing health funds here with Savvy today.

What is orthodontics and does health insurance cover it?

Orthodontics is a branch of dentistry which deals with misaligned teeth and bite patterns, including issues with the shape or alignment of the jaw. Insurance cover for the cost of orthodontics is provided by extras health insurance. This can cover braces, retainers or teeth aligners, as well as other treatments to ensure the teeth develop and align correctly. This can include removing wisdom teeth before they emerge if there is insufficient room in the mouth for these large back teeth.

Medicare doesn’t cover orthodontics (unless the need for teeth re-alignment is part of a bigger issue, such as a baby born with a cleft palate). Therefore, orthodontics treatments such as braces, aligners and retainers can be very expensive, costing anywhere from $5,000 to $18,000.

Private health insurance in the form of extras cover can help parents with the cost of such treatments. An extras policy may also cover other treatments received out of hospital, such as:

General and major dental
Optical (glasses or contact lenses)
Physiotherapy
Remedial massage
Chiropractic treatment
Podiatry
Speech therapy
Dietetics
Psychology
Hearing aids

The coverage offered by extras policies is not as tightly regulated by the Australian Government as the cover provided by hospital cover policies, so there’s more variation between health funds and the range and level of cover they offer. Be aware that not all extras policies which provide dental cover will also cover orthodontic treatment. For this reason, it’s important to check individual policies to make sure that orthodontics is covered if you think your child may need this type of treatment.

Savvy can help you get extras cover quotes to compare side-by-side. If you need further assistance, you can also request a call-back and have a health insurance specialist phone you to help you with your choice. Start your comparison process through Savvy today!

How do I compare extras health insurance policies which include cover for orthodontics?

Some areas to consider when comparing extras policies include:

Benefit limits

Most health treatments and services provided to outpatients are subject to benefit limits under an extras cover policy. These limits determine how much you can claim back on your policy in one year or over the lifetime of the policy. Benefit limits include the following:

Annual limits: the amount you can claim on your policy for a particular service in one year. For example, you may have an annual limit of $800 on orthodontics in any one year
Lifetime limits: how much you can claim back in total over the lifetime of the policy. For example, this may be capped at $2,000 or $4,000 to claim back on orthodontics depending on whether you buy a cheaper or more expensive extras policy. The fewer the restrictions and the higher the benefit limits, the more your extras policy will likely cost.

Some health funds work on the Australian financial year, so benefits reset on July 1, while other funds use the calendar year, which means benefits reset on January 1.

Percentage claim back

How much you will be able to claim back on the cost of braces or teeth aligners if you have an extras policy will depend on the level of cover you decide to buy. It can vary from 50% of the out-of-pocket cost under cheaper policies up to 85%. The more comprehensive the policy you buy, the more you’ll pay in premiums, but the higher the level of cover you will receive. Compare the percentage claim back as well as the annual limit when looking at different policies to see which offers the best value.

Waiting periods

All health insurance extras policies come with an initial waiting period before you can claim for orthodontic treatment. This is usually 12 months but can be as long as two or three years. This prevents people from making a large claim and cancelling their policy, which would raise the cost of health insurance for all Australians.

Cost

The cost of extras cover can vary significantly between funds and levels of cover. A more basic policy will be cheaper, but will likely offer lower annual and lifetime policy limits and a lower percentage of the cost of treatment that you can claim back. Be sure to compare similar policies to help you save on your orthodontics cover.

Special offers

If you’re thinking of swapping funds, look out for special offers such as free weeks of insurance or waived waiting periods. You can find out the latest offers and compare costs from a panel of insurers through Savvy by getting a free quote.

Types of health insurance

Hospital cover

This can help you pay for medical treatment if you need to be admitted to hospital. It can help cover the cost of your admission or accommodation and the fees charged by doctors, surgeons and anaesthetists. It can also cover other costs associated with a stay in a private hospital.

Extras cover

This helps cover the costs of health care treatments outside a hospital setting which aren’t covered by Medicare. This can include major and minor dental treatment, orthodontics, hearing aids, physiotherapy, glasses, contact lenses and podiatry (in most cases with annual limits).

Cover for singles

This is a standard health insurance policy designed for a single person, rather than being tailored to cater to the needs of a couple or family. It may include hospital cover plus extras, or either of these types of insurance on their own, depending on what you're after for your health cover.

Cover for families

A family health insurance policy is designed for a family unit including dependent children who may reach up to 31 years of age with some insurers. It offers private health insurance suitable for the whole family and may include shared limits for all members included in your policy.

Cover for seniors

A health insurance policy aimed at seniors is designed to appeal to people who are in the second half of their life. These are often specific Silver Plus policies that offer the same cover as other health insurance policies, with the exception that pregnancy and childbirth cover may not be included.

OVHC

Visitors who are in Australia on a temporary basis for travel, work or study may be able to take out Overseas Visitors Health Cover (OVHC). Many visas issued in Australia come with a requirement to take out this type of insurance, which covers visitors who may not be covered by Medicare.

Ambulance cover

Ambulance cover is generally available either packaged into your private health insurance or on its own as a separate policy or subscription. By having this protection, you could be covered for all eligible ambulance travel in Australia (subject to your insurer's terms and conditions).

Basic hospital cover

The cheapest and most barebones form of private hospital insurance, this can include cover for rehab, in-hospital psychiatric services and palliative care. Having this policy will enable you to avoid paying the Medicare Levy Surcharge (MLS) and Lifetime Health Cover (LHC) loading.

Bronze hospital cover

Bronze hospital cover is a step up from basic insurance, including 18 further clinical categories such as ear, nose and throat, bone, joint and muscle, digestive system, joint reconstructions, gynaecology and chemotherapy, radiotherapy and immunotherapy for cancer.

Silver hospital cover

Silver hospital cover is the second-most expensive type of policy and offers the second-most clinical categories. On top of what's offered by basic and bronze cover, it also includes heart and vascular system, lung and chest, blood, hearing device implantation and dental surgery.

Gold hospital cover

The highest level of private hospital insurance available in Australia, gold policies can offer cover for pregnancy and birth, weight loss surgery, assisted reproductive services and insulin pumps on top of all the categories provided by silver, bronze and basic hospital insurance.

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Frequently asked questions about health insurance for orthodontics

Can I spread out the cost of my child’s braces over two years?

Many patients time their orthodontic treatment around benefit reset months, so they can claim the cost over two or three years. For example, if your child needs braces, the initial preparation work could be performed in December, with the actual purchase and fitting of the braces taking place in January, so the cost is spread over two benefit years (assuming your health fund works on calendar years). Many dentists are asked to provide treatment for braces over two or even three financial or calendar years so the cost can be spread out more.

Does orthodontics come under major dental treatment in an extras policy?

Not usually – most higher level extras policies have four distinct categories for dental and teeth treatments, each with its own annual and/or lifetime limits:

General dental (including routine check-ups, cleaning, polishing and minor fillings)
Major dental (which includes crowns, bridges, restorative fillings, inlays and caps)
Orthodontics (which includes braces, bands, teeth aligners and dental plates)
Endodontics (which includes care for the inside of teeth and the gums, which is commonly called root canal work, and can include wisdom teeth removal)

Can my health insurance for orthodontics cover me if I need jaw surgery?

Jaw surgery to correct a misaligned bite is usually performed in a hospital setting, as either a local or general anaesthetic is usually required. Therefore, jaw surgery may not be covered by an extras policy, but if you are admitted to hospital for your surgery, it may be partly or wholly covered by your hospital cover health insurance.

If I swap health funds, will I have to serve another 12-month waiting period to claim for orthodontics?

Possibly not. Waiting periods for a specific type of treatment generally only have to be served once. Once you’ve served your waiting period, you may not have to re-serve it if you swap health funds and take out a similar level of cover. However, this can vary significantly between providers and a new health fund doesn't have to recognise already-served extras waiting periods under Australian law. For this reason, it’s important to read the Private Health Information Statement provided with your insurance policy so you know exactly what the terms and conditions will be if you do change providers.

Can private health insurance cover the cost of dental implants?

Yes, dental implants can be covered by private health insurance. Implants come under the major dental category in extras policies, but often there is a 12-month waiting period before you can make a claim for implants. Benefit limits for implants may also apply.

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