Does Medicare Cover Dental?

Here at Pearlii, we understand that the onset of a throbbing toothache is hardly the ideal time to start researching Medicare’s dental coverage. The system is confusing, and despite the fact that Medicare is considered a ‘universal health insurance scheme for all Australians’, reimbursements for dental care are limited. 

So, to help you out, we've done the heavy-lifting for you. We’ve gathered all the information on the different benefit groups, and created a quick explainer on what the coverage provides. We’ve also looked into whether cosmetic treatments are ever covered, plus we explore what happens if you need your wisdom teeth removed.

Providing dental care means taking care of your teeth and mouth by a dentist, dental specialist, or other health professional. Dental services in Australia are provided by either public or private dentists. The cost of dental care varies widely from dentist to dentist. The reason for this is that dentists do not have standard fees as doctors have. The cost of dental care differs depending on where the dentist practices and what methods he or she employs.

Bottom line: unlike other types of health care, the Australian government does not cover the costs of most dental services. In most cases, patients are responsible for paying dental expenses. However, Medicare pays for some essential dental services for those children and adults who qualify.

Under this plan, children ages 2 to 17 receive $1,000 over two calendar years for basic dental services, including x-rays, dental check-ups, fillings, cleaning, root canals, and extractions. The plan excludes orthodontics and cosmetic dentistry, as well as hospital dentistry.

There are no charges for the majority of services because they are bulk billed. Families who are already receiving other government benefits are eligible to receive the payments. Visit the Services Australia website to determine if your child qualifies.

State and territory dental plans cover both children and adults. In addition to emergency treatment, patients may be referred to specialist services such as orthodontic treatment at hospitals. In general, adults who wish to benefit from the program should have a Health Care Card or Centrelink Pensioner Concession Card, but the rules vary according to where they live.

State and territory dental services differ, and waiting times can be greater than a year for a visit with a dentist. For information about what health services are available in your area, visit the website of your state or territory health department. Under the Cleft Lip and Cleft Palate Scheme, those less than 28 years of age are eligible for Medicare benefits associated with some dental treatments and surgeries.

The following services should be available to Medicare beneficiaries who qualify for dental coverage:

Diagnostic

If a dentist needs to perform a particular procedure in order to diagnose an issue, this would usually be covered.

Preventative

Up to a certain limit, procedures such as scaling and cleaning are covered for eligible groups. This is because it prevents costly, more serious dental problems from occurring in the future.

Oral Surgery

The cost of surgery on the mouth or teeth is sometimes covered. In many cases, though, the dentist will refer you to the hospital to be treated there.

Here's the million dollar question.. Can you get reimbursed for wisdom teeth removal? The answer is... It depends. Wisdom teeth removal may be partially covered by some states, including NSW, WA, and NT. In order to have your wisdom teeth removed, you must have a valid medical reason. It would be wise to speak to someone at your state's local clinic about getting financial assistance and go to a bulk billing dentist - otherwise, the expense of tooth extraction is high without private health insurance coverage.

Keen to correct a crooked smile? Medicare will help cover severe cases causing major health concerns, but not if the braces are needed for purely aesthetic reasons. Teeth whitening also falls under the umbrella of cosmetic dentistry, and therefore is not reimbursed by Medicare. 

Teeth whitening done in the chair can tend to be quite expensive, but varies depending on the practice. For an option that is safe, proven to work and much more cost-effective, whitening products from Pearlii are made in line with the Australian Dental Association safety standards. Best of all, for every Home Teeth Whitening Kit sold, Pearlii will give back 50% of its profits to provide free dental surgery for people who can’t afford or access a dentist.

Now that you have graduated from Pearlii's Medicare information session, you should be well-equipped with all the information you need about dental coverage. 

What are you waiting for? Add that whitening kit to your cart now!