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Are Braces Covered by Health Insurance in Australia?
If you’re considering braces then one of the first questions you may ask yourself is: are braces covered by health insurance? The answer to this question depends on your level of cover, your health fund waiting periods, benefit limits and type of orthodontic treatment you need.
Ortho treatment (braces) in Australia is usually linked to Extras cover rather than the standard Medicare system. Not every Extras policy covers orthodontics and policies can vary greatly in how much they pay for orthodontics.
Does Health Insurance Cover Braces?
Yes some private health insurance policies cover braces but only when orthodontics is specifically included in your Extras cover.
For example, on the Australian Government’s PrivateHealth.gov.au site you can see that orthodontic benefits are listed for current private health insurance policies but annual and lifetime limits vary; some policies provide benefits for braces after a 12 month waiting period while others do not cover it at all (the amount covered varies between policies).
This means that just because you have private health insurance does not mean your braces will be fully covered.
Your policy may have:
- An orthodontic waiting period.
- An annual benefit limit.
- A lifetime orthodontic limit.
- Percentage rebates.
- Eligibility criteria.
- When you can claim.
- Benefits for different orthodontic services.
Is Orthodontic Treatment Covered Under Extras?
Orthodontic treatment is usually listed separately in the Extras section of a health insurance policy.
For example, some current policies list orthodontics with a 12 month waiting period and a specific benefit limit (the limits can vary widely between policies).
Some policies may offer a fixed dollar benefit while others pay a percentage of the eligible treatment cost up to the applicable limit.
So before starting braces check your policy (rather than assuming all orthodontic costs will be covered).
How Much Do Health Funds Pay Towards Braces?
There isn’t one standard amount that Australian health funds pay for braces.
For example, current policies listed on PrivateHealth.gov.au show orthodontic limits ranging from hundreds of dollars per person to several thousand dollars depending on the policy; some policies also have lifetime limits.
Consider a simple example:
So if your orthodontic treatment costs $6,000 and your policy has a lifetime orthodontic benefit of $1,500 (rules apply), your insurance may only pay up to the applicable $1,500.
The rest would usually be paid by you.
Important: The actual amount you can claim depends on your individual health insurance policy and treatment received.
What Should You Check Before Getting Braces?
Before you start orthodontic treatment ask your health fund about:
- what will happen when you start treatment (e.g. do I need a referral from my GP or specialist);
- whether there is anything I need to do before starting treatment (e.g. get X-rays of my teeth);
- how much treatment will cost; and
- what happens at the end of treatment (if any).
1. Does my policy cover orthodontics?
Not all Extras policies include orthodontic benefits. Make sure orthodontics is specifically covered.
2. Have I waited the waiting period?
Sometimes a waiting period applies before you can claim orthodontic benefits. Some policies list a 12 month waiting period for orthodontics (see above).
3. What is my annual benefit?
Some policies have an annual limit on orthodontic claims. This can affect how much you can claim each policy year.
4. Is there a lifetime limit?
Some policies set a maximum lifetime benefit on orthodontic treatment. Current examples are $1,800 lifetime limit; $2,200; $2,900 and $3,000 (depending on policy).
5. Does the policy cover my specific treatment?
Ask if the benefit covers the type of orthodontic treatment being recommended (braces and components included).
Are Braces Covered by Medicare?
For most people Medicare does not cover routine orthodontic treatment like braces. Private health insurance Extras cover may provide benefits if orthodontics is covered in the policy.
Since orthodontic treatment can be expensive, knowing your insurance coverage before treatment starts will help you plan your budget.
What If My Health Insurance Does Not Cover Braces?
You can still discuss your options with a dentist or orthodontist. Depending on your dental needs there may be different treatment approaches and payment options available to you.
During consultation ask about:
- Recommended orthodontic treatment.
- Estimated treatment costs
- Expected duration of treatment
- What your health fund may cover
- Out-of-pocket expenses
- Available payment options
Your dentist can also explain whether braces are appropriate for your particular dental and alignment needs.
How to Check Your Braces Insurance Coverage
Contact your health insurer before booking treatment and ask specifically about orthodontic benefits. It can be useful to ask for the information in writing so you know what limits apply and waiting periods.
Next, you can discuss the treatment plan and estimated costs with your dental provider.
Planning Braces in Parramatta?
If you’re thinking about braces in Parramatta and want to know what options are available and how much they will cost, contact us for a consultation.
As a trusted dentist in Parramatta we can assess your dental needs, explain which treatment option is suitable and help you understand the costs involved.
Book a dental consultation in Parramatta today and take the next step towards a healthier more confident smile!
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