Are Dentures Covered by Medicare?

If you wear dentures, you’ll want to know what funding methods are available for you. This is necessary as you need to visit your dental prosthetist regularly to maintain your dentures.

Now It would certainly be a blessing if the country’s main healthcare fund Medicare, covers the cost of these visits.

The Department of Health develops the Medicare policy while Australia’s Department of Human Services administers Medicare and will pay for you the benefits if you are eligible.

So, does Medicare cover dentures?

dental prosthetist

It’s important to understand Medicare and how it works so that you’ll know if it covers denture outlays. You are eligible if:

  • You are a permanent Australian resident
  • You are a citizen of Australia or New Zealand
  • You have applied for permanent residency and meet a few other basic criteria – this excludes applications for parent visas, and;
  • You are a beneficiary of a Reciprocal Health Care Agreement cover by another country.

If you pass any of these eligibility criteria, you are issued with a Medicare card that represents your enrolment to the fund. You need to be at least 15 years old to have your own Medicare card. Children below 15 can be a beneficiary of their parents’ Medicare.

What is covered under Medicare?

Dentist office

 

  • Treatment that health professionals provide can either be free or subsidised. These professionals include doctors, optometrists, specialists, as well as other allied health practitioners and dentists in specific circumstances.
  • 75 percent of the Medicare Schedule fee for medical procedures and services. if you are a private patient in a public or private hospital. (excludes hospital accommodation and additional items like theatre fees and medicines.)
  • Free treatment and accommodation in public hospitals for public Medicare patients.

For dental care, Medicare only covers treatments if they are deemed to be essential for the well-being of the patient.

Dental Hygiene of Teeth with Braces

This means that dental procedures that will enhance your appearance (cosmetic purposes) are not covered by Medicare. The underlying assumption is that the life of the patient does not depend on the item of cosmetic adjustment.

Because  most general dental treatments and examinations are not essential to the wellbeing of the individual, these are not covered by Medicare. And when the dental service is covered, it may not cover the whole cost.

Dental procedures covered by Medicare

  • Oral surgery – Medicare covers specific oral surgeries if they are required for particular non-cosmetic purposes.

Dental technician

  • Diagnostic – The fund will cover diagnostic procedures recommended by medical practitioners. Examples here include dental x-rays.
  • Preventative – Procedures that help prevent greater and costlier dental problems from developing later on such as cleaning and sealing are provided limited cover.

costlier dental problems from developing later on such as cleaning and sealing are provided limited cover

 

      • Restorative – Restorative procedures such as dental implants and root canal therapy are covered partially. Though this only happens in some states and territories and not the whole country.

Each state and territory has its own public dental program. As such, they have their own schemes and eligibility requirements.

From the foregoing, dentures are not essentially covered by Medicare. So it is advisable that you get your dentures from a clinic that works in partnership with established health funds to ensure you have prompt and efficient payment processing for all your private health fund claims.

Note: Even though dental procedures intended primarily for cosmetic purposes are not covered, essential treatments may bring with it improvement in the patient’s appearance.

How Medicare covers dental procedures

The Federal Government provides funding for dental treatments for eligible grownups and children through various schemes that are not mainstream Medicare. These include:

Child and Adult Public Dental Scheme

This scheme has been introduced as a replacement of the Child Dental Benefits Schedule to provide ongoing funding in partnership with states and territories. This scheme aims to assist in covering public dental services for all children as well as for adults with concession cards.

Child Dental Benefits Schedule

This has since been replaced with the Child and Adult Public Dental Scheme. Under this scheme, eligible children aged between 2 and 17 years of old would access basic dental services. Children who were entitled to government benefits such as the Family Tax Benefit Part A would receive benefits capped at $1,000 per child every two years to cover services like examinations, cleaning, x-rays, fissure sealing, root canals, fillings and extractions.

When this was replaced with the Child and Adult Public Dental Scheme, the coverage was widened, to increase the number of beneficiaries.

Moreover, the scheme aims to improve the oral health of Australian people who are unable to afford private healthcare insurance.

Persons who can afford private health cover can also enjoy different levels of dental cover supported by the government through the extras cover. These may range from general preventative dental care to orthodontics and other major dental procedures.