April 29, 2019

Dental care is one of the major health services which is not covered by Medicare. To combat this, all private health funds include dental in their Extras cover. Our team took a closer look at some of Australia’s major private health funds and compared the benefits they offer for dental services.

Dental Covered by Medicare

The Child Dental Benefits Schedule (CBDS) is a scheme organised by the Government through Medicare. It gives eligible children aged between 0 and 17 access to $1,095 worth of basic dental services over a 2-year period. Learn more about the CDBS here.

Private Health Funds – Dental Extras Comparison

Health Fund	Extras Period	Fortnightly Cost*	Cover Name
ahm	Financial Year	$58.70	Bronze
bupa	Calendar Year	$50.70	Lite hospital, Your Choice extras 60
CBHS	Calendar Year	$50.94	Basic Plus Hospital with Intermediate Extras
HCF	Calendar Year	$56.25	Bronze Plus Hospital with mid extras
medibank	Calendar Year	$48.40	Bronze Everyday & Healthy Start Extras
nib	Calendar Year	$58.35	Bronze Plus

* All prices based on enquiries for female under 30 in QLD with income below $90,000/year and $750 hospital excess, enquiry date: 29/4/2019

Below we compare the 6 major health funds – ahm, bupa, CBHS, HCF, medibank and nib. In the table below, you can see the prices for each private health cover. All prices are based on enquiries for female under 30 in QLD with income below $90,000/year on 29/04/2019. They all include bronze hospital cover with a $750 hospital excess as well as an intermediate/bronze range of extras cover. 

Each health fund has different annual limits for general dental and major dental. The selected policies for HCF and Medibank have a combined limit for general and major dental of $500 whilst ahm, bupa, CBHS and nib have two separate category annual limits ranging from $500 to $750 per year. Interestingly, in total they all add up to similar amounts. For bupa and nib they have a limit of $1,200 per year, ahm pays a maximum of $1,250 for general and major dental whilst CBHS’s maximum benefit payment for preventative, general and major dental is up to $1,430.

Extras Benefits Claims

Ahm, bupa and HCF pay a fixed or variable dollar amount on the total price of the treatment. If your scale and clean is, for example $80, ahm will pay $74.45 whilst bupa would pay $28.50. This would leave you with a gap payment of $5.55 if you were with ahm or $51.50 with bupa. At Coastal Dental Care, we wave this gap payment for you if you are within your annual spending limits.

Other health funds such as CBHS, medibank and nib offer a payment of a fixed percentage of the treatment price. If you visit a preferred provider, you will receive between 60% to 70% back on the treatment items listed in the Dental Benefits in the table below.

This means if you are with nib, you would receive 60% of the $80 scale and clean costs back from nib which equals $48. The result is a gap payment of $32. Since you are with a private health fund and have available dental extras cover, all Coastal Dental Care practices would wave this gap for you. This means, for this treatment you would have no out of pocket costs.

Coastal Dental Care & Preferred Provider Status

All Coastal Dental Care practices are part of the nib first choice network. Please check the individual practice pages to find out if the location is preferred provider for bupa, CBHS, HCF and medibank.

The major dental category usually covers more extensive treatment items such as crowns, root canal treatment, and dentures.  

Dentures are partly covered by ahm, bupa, HCF and medibank. In contrast to all the other limits, with ahm, bupa and HCF dentures don’t have an annual limit but the limits renew only every three years.

Ahm, bupa, CBHS and nib have also included orthodontic treatment in their Bronze extras cover with annual limits ranging from $350 to $700. However, all funds have a lifetime limit of $1,300 up to $1,800.

Treatment	ahm	Bupa	CBHS	HCF	Medibank	nib
General dental annual limit	$500	$700	Preventative: $230 General: $500	Total limit: $650	Total limit: $500	$600
Periodic oral exam	$34.65	$14	70%	$32-$73	60%	60%
Scale & clean	$74.45	$28.50	70%	$36-$62	60%	60%
Fluoride treat-ment	$25.50	$14.50	70%	$27	60%	60%
Surgical tooth extrac- tion	$99	$62	70%	$ 157-250	60%	Under major dental, 60%
Major dental annual limit	$750	$500	$700 (crowns and bridges)	Combined dental limit	Combined dental limit	$600
Fully veneered crowns	$510	$500	70%	Placing crowns+ bridges$238- $600	60%	60%
Root Canal	$120.55 (limit: $600)	$125 (annual limit: $500)	70% (annual limit: $400)	$27- $248	60%	60% (annual limit: $600)
Denture	Full set every 3years	Once every 3 years	Not incl.	$25-600(limits renew every 3years)	60%	No data
Annual limit ortho- dontics	$600 (lifetime $1,800)	$450 (lifetime $1,300)	$700 (lifetime $1,400)	Not incl.	Not incl.	$350 (lifetime $1,500)

Restrictions on Dental Extras

In addition to the annual limits, some health funds also have restrictions on services. Ahm, for example, allows patients a maximum of two examinations, three scale and clean appointments and two fluoride treatments per year. HCF has a similar policy allowing a maximum of two check-ups, 2 scale and clean and one fluoride treatment a year.

Please be aware that there are several other policies offered by all private health funds. We recommend undertaking research using your specific details and situation to determine the best private health fund policy for you.

Ask your Health Fund

Before commencing any extensive treatment, we always recommend contacting your private health fund. During your consultation with your Coastal Dental Care dentist, you will receive an itemised treatment plan. The item numbers will help your health fund to exactly determine how much you can claim under your policy.

You can also book your consultation or No Gap check-up and clean appointment at one of our Coastal Dental Care practices online 24/7. If you have any questions, please don’t hesitate to contact our friendly team members at our practice locations.