Medicare Teen Dental Plan

With Medicare not providing much help with dental care for most people, many families struggle to afford dental cover. This can be worrying for parents, as it may mean that youngsters struggle to maintain good oral health later on as they have not got into the habit. The Australian government has recognised this concern, and introduced the Medicare Teen Dental Plan in 2008. This is designed to make annual dental check-ups more affordable and get teenagers used to taking care of their teeth.

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Is your teen eligible?

The Medicare Dental Plan covers eligible teenagers aged 12-17. He or she must be eligible for Medicare. Certain benefits also need to be received by the teenager themselves or their family, guardian or carer. These conditions only need to be met for a single day in the calendar year in some cases. A letter will be sent to you to if you are eligible – there is no need to apply.

What is covered?

The Medicare Teen Dental Plan is designed to make preventative check-ups less costly. The voucher covers an oral examination, but may also include x-rays, a scale and clean, a fluoride treatment and fissure sealing if needed. If the check-up indicates that any other dental work should be carried out, it will not be covered by this voucher.

How it works

Once the voucher has been received, there are several steps that you need to take.

1. Making an appointment. Firstly, you need to book an appointment for the check-up. Be sure to confirm that the dentist will cover the check-up under the Medicare Dental Plan, as not all will necessarily accept the voucher. Ask about the costs too – some dentists will charge more than the $163.05 claimable from Medicare, which would leave you with out-of-pocket costs to cover.
2. Attending the appointment. Take your Medicare card along with the voucher.
3. Claiming the Medicare benefit.
• Your dentist may bulk bill Medicare directly. This does not require you to do anything other than sign an Assignment of Benefit form.
• However, your dentist may ask you to pay upfront, and you can then claim the cost back from Medicare.
• In some cases, you may need to take an unpaid account to Medicare. You will then receive a cheque to give to your dentist. If your dentist charges above the Medicare benefit, you will need to pay the difference.

Beyond the Medicare Teen Dental Plan

The Medicare Teen Dental Plan is designed to cover check-ups. If your teen is lucky, this may be sufficient, but you cannot count on this to be the case. If your teen needs dental work or is not eligible for help from Medicare, a private health fund may help with your dental costs.

Private health insurance is not always as expensive as you might think. Compare health insurance policies to find a plan that fits the needs of the whole family. Look into the details of extras cover like dental plans during your health insurance comparison, as there can be variations in the items covered and the amount you can claim.

Is Ancillary Cover Worth Having?

You can’t compare health insurance without noticing the range of extras on offer. If you have not previously looked at your health insurance options, you may wonder whether these are worth having. Here is some information on what is likely to be covered and why you might need it.

What does hospital cover include?

As the name suggests, you are covered for in-hospital services. For out-of-hospital services, you can arrange additional extras cover. Extras cover is often combined with hospital cover. This may be a set package of extras, or you may be able to choose which extras you want. Having hospital cover alone will help to keep health care costs down. However, you may also want cover for many non-hospital services that you may need.

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Why you might need ancillary cover?

Ancillary cover will help with out-of-hospital costs. Just a few of the options include dental, optical, podiatry and pharmacy. Many of these are not covered through Medicare. Here are a few examples of ancillary options for which Medicare only provides basic cover, or none at all.

• Dental. Basic dental treatment is covered for teens through the Medicare Teen Dental Program. The chronically ill can get some dental care through the Chronic Disease Management Program. For the latter, the health condition must be likely to affect oral health.
• Optical. Eye tests performed by optometrists are covered by Medicare. If you need glasses or contact lenses, these are not covered by Medicare.
• Complementary therapies. These are not usually covered. For example, acupuncture is only covered if it forms part of a doctor’s consultation.
• Physiotherapy/podiatry/chiropractic. None of these are covered by Medicare unless you qualify for the Chronic Disease Management program.
• Ambulance services. These are not covered by Medicare. Queensland and Tasmania have free ambulance services, but in other states you may need ambulance cover.
• Pharmacy. Many medicines are subsidised through the Pharmaceutical Benefits Scheme (PBS).  However, not all medicines are. This extra insurance covers non-PBS medicines.

Waiting periods

Many extras carry waiting periods that must be served before you can claim. How long you have to wait depends on the extra in question. Extras such as general dental, physiotherapy, palliative care and psychology carry two month waiting periods. Major dental cover has a longer wait time of twelve months. The lesser waiting periods may sometimes be waived by health funds as a sign up bonus.

Cover levels

Depending on your policy, you may not be covered for everything. For example, having dental cover does not mean that you are covered for all dental work. Having basic cover means that there will be limits. This makes it crucial to compare health funds to look at your options. Expect out-of-pocket expenses if you need treatment that is not covered by your policy.

Ancillary cover will provide benefits for out-of-hospital services. Exactly what you are covered for depends on your policy level. Basic cover is cheaper, but not very broad. Be sure to compare health insurance policies as not all are the same.

Commonwealth Seniors Health Card

As you get older, you may worry about how you will be able to carry on funding your health care. For many seniors, your health needs may be changing at a time when your income is decreasing.

If you already have private health insurance, you may worry about how to afford to maintain enough cover for your needs. If you don’t already have health insurance, Lifetime Health Cover loading fees may make you feel that you cannot afford to compare health insurance. Even if you can afford to continue being a health fund member, you may worry about meeting the out-of-pocket costs that are not covered by this. This may seem like a scary prospect, but there is hope.

Thankfully, there are various concession cards that can help you out. One of these is the Commonwealth Seniors Health Card (CSHC). This can lower your costs for PBS medicines. It can also help with the costs of other health services.

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Commonwealth Seniors Health Card Eligibility

Could you be eligible for the CSHC? You must satisfy the following eligibility criteria.

• You are an Australian resident
• You are not serving a waiting period as a new Australian resident
• You are of Age Pension age, but are not eligible for the Age Pension
• You are not receiving Social Security or DVA benefits
• You must provide Centrelink with the Tax File Number for you and your partner (or be exempted from doing this)
• You must meet the adjusted taxable income criteria. This is currently $50,000 (singles) and $80,000 (couples). For dependent children, the threshold goes up by $639.60 per child. Not sure what counts as taxable income? Check with Centrelink to confirm. Super payments for over 60s are usually tax-free, but this is not always the case.

How It Works

The CSHC entitles you to discounts on PBS medicines. You may also benefit from being eligible for the Medicare Safety Net, which would reduce your out-of-hospital costs on medical services assuming that you meet the threshold. Another major benefit is bulk-billing rates for doctor appointments. GPs are encouraged to adopt bulk-billing, but they are not obliged to do so.

The CSHC does not cover your dependents. If you want them to be able to benefit too, there is an alternative concession card. The Low Income Health Care Card offers the same benefits as the CSHC but also covers dependents.

Getting the Card

You can register your claim online via an Intent to Claim. In effect, this informs Centrelink of your intention to apply for a concession card. You will need to make your claim within 14 days of your Intent to Claim. You can also claim by paper form, by telephone or in person at a Centrelink centre.

Need help with your health care costs as you get older? This is a big concern for many seniors. Don’t forget to compare health cover – it may not cost as much as you think. Beyond this, concession cards can make things a bit easier. For example, the CSHC can help with buying PBS medicines and can also reduce medical costs. This can be a big help for many seniors but not everyone will be eligible.

Feeling Tired All the Time? What Your Health Insurance Covers

Are you feeling tired a lot or struggling with other worrying health issues? You’ll want to get it looked into. Many people are reluctant to consult their doctor out of fear for what it may cost. You may be aware that Medicare will cover GP consultations, but what happens beyond that?

If your tiredness symptoms need further investigation, you’ll want to know if you’re covered for tests and appointments with specialists. Here is a guide to what can be covered through Medicare and what you will need private health insurance for if you want to minimise your out-of-pocket expenses.

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What does Medicare cover?

GP consultations. Medicare will reimburse 100% of the Medicare Benefits Schedule fee for visiting a doctor outside of hospital. There is no fee for you to pay if his or her fee is the same as the MBS fee. It may not work out like this, though, as GPs can choose to charge above the MBS fee. This difference between the GP’s fee and what Medicare will cover mean that there may be out-of-pocket costs that you have to pay.

Specialist consultations. Medicare will reimburse 85% of the MBS fee. Even if the consultant’s fee is in line with the MBS fee, there is still the remaining 15% to cover. Specialists, like GPs,  may charge more than the MBS fee, so check the fees before you see a specialist for your fatigue issues.

Diagnostic tests. If your doctor advises that tests are necessary to discover the reasons why you’re feeling so tired, Medicare may cover the costs. Many tests and examinations come under this cover, including x-rays.

If your doctor bulk bills, you pay nothing as they bill directly to Medicare. If they do not bulk bill, you need to pay the difference between their fee and what Medicare will cover. This may involve paying your doctor in full, sending your receipt to Medicare and being reimbursed for the MBS fee amount. Or it may involve being given a cheque to give to your doctor along with any balance that you still owe.

What does the Medicare Safety Net cover?

The costs can soon mount up if you find that you need regular consultations with a doctor who charges above the MBS fee. The Medicare Safety Net is in place to help with these out-of-pocket costs. If your out-of-pocket costs reach the Safety Net threshold, 100% of the MBS fee for eligible services will be reimbursed through Medicare. There may still be out-of-pocket costs to meet though. The Original threshold for all Medicare cardholders is $413.50 in March 2012 . For concession cardholders and families eligible for FTB(A), the threshold is $598.80.

If your out-of-pocket costs reach a certain amount, the Extended Medicare Safety Net can help. For out-of-hospital services, up to 80% of your out-of-pocket costs can be covered. Some services are capped so you will not get this level of help on those. Getting to the bottom of your symptoms should be covered as consultations with GPs and specialists are included in the safety nets. Many diagnostic tests are also covered. The Extended threshold is $1198 in March 2012. This is for all Medicare cardholders.

Will private health insurance help?

The main intention of private health insurance is to cover services that would otherwise be unavailable or unaffordable. Services that are available through Medicare are not covered. More specifically to this scenario, medical services provided out-of-hospital, such as GP visits and consultations with specialists, are not covered by private health funds. The gap between the MBS fee and the fee charged may be covered by Medical Gap insurance.

However, you may choose to compare health insurance for private hospital cover, which may give you greater choice about where, when and from whom you receive treatment. This may be reassuring if you feel that your condition warrants swift attention, for example if tiredness is affecting your ability to work. You may also want to look into extras cover for specific treatments such as chiropractic or optical care, in case you need to access these services in the future.

Summing things up

Are you worried about arranging a consultation with your GP in case the costs start to grow beyond your budget? Remember that Medicare will cover 100% of the MBS fee for GP visits. It also covers 85% of the MBS fee for consultations with specialists. There may still be some out-of-pocket fees if your doctor charges above the MBS fee but Medicare should cover the bulk of the costs. Health insurance will not help with the costs of out-of-hospital medical services, but you may be able to use gap insurance to minimise your out-of-pocket costs.

Dental Care and Your Private Health Cover

For many Australians, oral health has become less of a priority and many now avoid the dentist unless they have problems. This may seem sensible at first if you are looking to keep costs down, but neglecting your teeth can prove costly later on. Keeping your teeth healthy is a wise investment, and here’s some good news: a private health fund can cover some of the costs with dental insurance.

Can I get help through Medicare?

There is good reason why dental is such a popular health insurance extra. Medicare provides only limited dental care. Getting help with dental costs through Medicare is not possible for many people. However, you may be able to receive dental care through Medicare through the following programs if you qualify.

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Medicare Teen Dental Plan

This program is designed to make dental check-ups more affordable for families with teenage children. Is your teen eligible for this? Firstly, he or she must be aged between 12 and 17. He or she must also be eligible for Medicare. Beyond this, certain benefits need to be received. You can see more details about eligibility on the Medicare Teen Dental Plan website.

Chronic Disease Management program

You must meet the criteria and be referred to a dentist by your GP to be eligible. You must have a chronic condition requiring complex care. This must have been present for six months or more. Your oral health must be deemed to be affecting your general health or have the potential to do so. If eligible, it covers things like assessments, preventative treatment, fillings, extractions, restorative work and dentures. Speak to your GP if you think that you may qualify.

Why do I need dental insurance?

When money is tight, many people think twice about having dental insurance. Far from being an unnecessary expense, it can actually save you money in the long run. Making the effort to maintain good dental health can help to protect against bigger expenses further down the line. Regular check-ups can catch problems before they become more serious – and more expensive.

What dental cover can I get?

Some health funds have ‘no gap’ schemes. This means that preventative and diagnostic services do not have ‘gap’ payments and you will not be out-of-pocket. Other services are at generally at lower cost too.

Some health funds will have agreements with providers so that you are charged less for dental treatment. How much you will get out of this largely depends on your coverage level. Always compare health funds – some may have unlimited benefits, but other may have annual maximums.

Bear in mind that there may be little scope to use your existing dentist under the cover of your new health fund. Want to keep your own dentist? When you compare health insurance, make sure that you look at whether your current dentist is a part of their coverage network. Some health funds will let you choose your dentist, so if you are keen to keep the same dentist, you may prefer to look for health funds that don’t limit cover to their selection of preferred or participating dentists.

If you have got dental cover, your health fund will cover some of your dental care costs. It is important to have an adequate level of coverage for your needs, as you may find very limited cover offers less value for your premium.