Does Medicare Cover Dental? Find Out What’s Included and How to Save

Australia’s Medicare system is a key part of our healthcare system, offering subsidies and free care for many medical services. However, a common question many Australians ask is: does Medicare cover dental care? 

The answer is that Medicare’s coverage for dental services is quite limited. Although Medicare does provide some coverage for specific dental treatments, the extent of this coverage is quite restricted. It means that most dental procedures, from cleanings and fillings to dentures and extractions, are not covered by standard Medicare plans. 

The Evolution of Medicare in Dental Care 

When Medicare was established in the 1960s, dental care was generally considered a preventive service rather than a medical necessity. As a result, it was excluded from the program’s coverage. 

This historical decision has had significant implications for Australian oral health. Without the financial support of Medicare, many Australians have struggled to afford regular dental check-ups and treatments. This has led to a higher prevalence of dental problems, such as tooth decay and gum disease, which can have serious consequences for overall health. 

Over the decades, the understanding of oral health has evolved significantly. Research has increasingly demonstrated the strong link between oral health and systemic diseases, including heart disease, diabetes, and respiratory infections.  

This growing body of evidence has led to a shift in perspective, and as a result, Medicare has introduced dental coverage for specific groups, such as children from low-income families, through initiatives like the Child Dental Benefits Schedule.

Child Dental Benefits Schedule (CDBS) 

The CDBS is the only Medicare program available and is part of the ‘Grow up Smiling’ initiative. This program provides financial assistance to eligible families for children’s dental care. Since its launch in 2014, the CDBS program has delivered essential dental care to over 3 million Australian children every year.  

Eligibility and Coverage 

CDBS covers basic dental services like dental x-rays, check-ups, cleanings, fillings, extractions, fissure sealing, and root canals for children aged 2 to 17. To qualify, families must be recipients of government income support, including payments like Family Tax Benefit Part A or any other government payment, including ABSTUDY, disability support pension, and youth allowance. 

Benefits and Limitations 

The CDBS provides up to $1000 of benefits in the form of preventative and basic dental treatments for each eligible child over a period of two years. This means: 

• Starting from the beginning of the calendar year in which the child turns two.  
• Any unused benefits from the first year can be carried forward to the second year. 
• However, any remaining balance after the second year is lost. 

Example: 

• If a child turns two on January 15, 2023, the two-year CDBS period starts on January 1, 2023, and ends on December 31, 2024. 
• If the child uses $700 worth of dental services in 2023, they will have $300 remaining for dental services in 2024. 
• Any unused funds after December 31, 2024, will be lost. 

Important to note: 

• The $1000 cap is per child, not per family. Each eligible child in a family receives their own $1000 limit. 
• The CDBS only covers basic dental services. More complex treatments like orthodontics or cosmetic dentistry are not included. 

How To Enrol Your Child in Medicare 

Enrolling your child in Medicare is a crucial step to ensure they receive the healthcare coverage they need. Here’s how you can add your baby to your Medicare card and what you need to do if your child is older: 

Add Your Baby to Your Medicare Card 

It’s essential to update your Medicare card to include your newborn baby as soon as possible. This ensures that your child is covered under your Medicare plan and can access necessary healthcare services. Once you have added your baby, the government will send you an updated Medicare card reflecting this addition. If you use the Express Plus Medicare mobile app, you’ll see your baby’s name on your digital card immediately. 

Enrolling Older Children 

If your child is over 12 months old, you will need to provide additional documentation. Specifically, you must present your child’s birth certificate to complete the enrolment process. This document helps verify your child’s identity and ensure that they are correctly added to your Medicare coverage. 

By promptly enrolling your child in Medicare, you can ensure they benefit from the comprehensive healthcare coverage provided by the program, making it easier for you to manage their health needs effectively. 

Dental Insurance Coverage for Adults 

Unfortunately, Medicare does not cover dental services for adults, making it essential to explore alternative options to meet your dental care needs.  

Why Dental Insurance is Important for Adults? 

Dental insurance can help cover a range of treatments and services, including routine check-ups, cleanings, and even more extensive procedures like crowns and orthodontics. Investing in a dental insurance plan ensures that you receive the necessary care without bearing the full financial burden out of pocket. 

Finding the Right Dental Insurance 

Navigating the world of dental insurance can be challenging, especially with the multitude of plans and providers available. Here are a few tips to help you find a suitable dental insurance plan: 

• Assess Your Needs: Consider your current dental health and any potential future needs. If you require specific treatments or have ongoing dental issues, choose a plan that covers those services comprehensively. 
• Compare Plans: Research and compare different insurance plans to find one that offers the best coverage for your needs at an affordable rate. Look for plans with low premiums and reasonable out-of-pocket costs. 
• Check Network Providers: Ensure that the insurance plan includes a network of reputable dental care providers. Access to a broad network can give you more flexibility in choosing a dentist. 
• Understand the Terms: Carefully review the policy details, including coverage limits, co-pays, waiting periods, and exclusions. Knowing these details helps you avoid unexpected expenses and make an informed decision. 
• Seek Recommendations: If you find the selection process overwhelming, consider seeking recommendations from friends, family, or a reputed healthcare provider. They may have valuable insights or personal experiences with different insurance plans. 

Does Medicare Cover Dental? Find Out Your Coverage Options at RS Dental Group

At RS Dental Group, we not only provide exceptional dental care tailored to meet your individual needs, but we also specialise in assisting with various dental insurance schemes to ensure you get the most from your benefits: 

• Child Dental Benefits Schedule (CDBS): We welcome children under CDBS, making it easier for families to access preventive and general dental care in both public and private clinics. 
• Victorian Emergency Dental Scheme (VEDS): For urgent dental issues like broken teeth, we provide emergency care for eligible adults when local clinics cannot offer timely treatment. 
• Victorian General Dental Scheme (VGDS): We accept patients covered under the General Dental Scheme for routine dental care, ensuring that all necessary treatments are provided. 
• Pensioner Denture Scheme (PDS): We offer denture services, including new dentures, relines, and repairs, through the Pensioner Denture Scheme for eligible adults. 

Our knowledgeable staff is here to guide you through your insurance options and help you make the most of your dental coverage, ensuring you achieve and maintain optimal oral health.