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Dental costs & COVID-19: ‘Perfect storm’ for Aussies’ teeth

9 min read
7 Aug 2020

The drill may not be the only thing keeping us from seeing our dentist; dental costs are causing many Aussies to delay or avoid their treatment altogether, as shown in the Australian Institute of Health and Welfare’s (AIHW’s) 31 July update.

In a statement about its oral healthcare report, AIHW spokesperson, Dr Adrian Webster, says the total bill may prevent many Aussies from ‘[receiving] the care they need, when they need it’.[1]

The statement also reveals those without health insurance are twice as likely to avoid treatment than those with cover.

Source: Australian Institute of Health and Welfare[2]

Dr Webster says poor oral health compromises our ability not only to eat but also speak and socialise, ‘resulting in pain, discomfort and embarrassment’.

 

COVID-19 only aggravates the toothache

The global pandemic is – quite literally – adding sugar to the wound, thanks to our tighter budgets, social distancing and growing sugary appetites.

Earlier in 2020, Australia implemented restrictions that saw dentists only carrying out urgent treatment. These restrictions are still in place in certain areas, like metro Melbourne as of 5 August.[3]

With all these factors combined, the Australian Dental Association (ADA) predicts a ‘downward spiral in the nation’s oral care’ once COVID-19 has passed.[4]

‘Plenty of people are stuck at home snacking more on sugary treats,’ explains Dr Mikaela Chinotti, ADA Oral Health Promoter, in a press release.

‘Others won’t head to a dentist as they’re concerned about virus transmission or public transport travel.’

Our increased sugar habit is also evident in April to May findings from the Australian Bureau of Statistics (ABS). This survey showed 22% of adults increased their consumption of unhealthy snacks.[5]

‘We’re anticipating a spike in the number of tooth decay and other oral health issues to emerge once the pandemic is over,’ says Dr Chinotti.[6]

As it is, the ADA’s Oral Health Tracker – updated for Dental Health Week (3-9 August 2020) – shows over one-quarter of Aussie adults have gum disease (periodontal pockets >4mm), which can cause tooth loss.[7]

What’s more, the Oral Health Tracker shows:

  • nearly one-third of adults have untreated tooth decay;
  • only 53% of us are brushing twice daily; and
  • three per cent of children aged five to six have experienced decay in primary teeth (according to the latest stats from 2012-14).[8]

How can Aussies navigate public and private dental care in 2020?

Publicly funded dental care for adults

Eligible adults can access publicly funded dental care in Australia. However, dental services and requirements can differ between states and territories.[9]

To find out more about available dental services and prerequisites near you, read more at the Australia Government’s Department of Health.

You may also be able to access low or no-cost dental services at university oral health clinics.

Waiting periods for public care

When it comes to publicly funded care, you may not receive your treatment right away. For instance, if you’re booked in for, say, a scale and clean, you may need to wait a few months before you’re seen by the dentist.

According to AIHW’s report, 90% of Victorians in the dataset waited – at most – over 1,000 days from the date they were placed on the waiting list to their first visit. This figure applied for general dental care in 2018-19.[10]

However, you’ll typically be seen sooner if your care is more urgent (this is known as a triage system).

Publicly funded dental care for children

The Australian Government covers part or the full cost of dental care for children aged between two and 17 years old. Such cover falls under the Child Dental Benefits Schedule.[11]

However, to receive cover under this schedule:

  • your child must be eligible for Medicare; and
  • you or your child must be receiving an eligible payment (like certain Centrelink payments) at least once a year.

These benefits cover up to $1,000 over two calendar years for basic dental services, including:

  • check-ups
  • cleans
  • x-rays
  • fissure seals
  • root canals
  • fillings
  • extractions.

The government doesn’t cover:

  • cosmetic dental work
  • orthodontics
  • any hospital dental services.

Some restrictions do apply for certain services, so it’s important you check with your dentist before your child visits to be sure.

elderly man brushing teeth in mirror

Claiming dental costs on your health insurance

Aussies can also turn to health insurance to access subsidised care for their oral health, without needing to sit through the public waiting system.[12] You will need to sit the insurer’s waiting periods before you can claim on dental services, though. These waiting periods can range from two months (for extras cover) and up to 12 months (typically for major dental or hospital cover) from when you purchase your policy.

Hospital cover

When it comes to more surgical dental care, higher tiers of hospital insurance can provide a level of cover. In these policies, you can be covered for things like wisdom teeth removal and dental implants.

Dental surgery cover comes standard in Silver and Gold hospital policies (and may be available in some ‘Plus’ hospital policies, like Bronze Plus).

Extras cover

For out-of-hospital treatment, Aussies can turn to an extras health insurance policy. This type of cover can also subsidise your prescription glasses from the optometrist and physio consultations, for example (up to the limits of the policy).

According to the Australian Prudential Regulation Authority (APRA), 13.6 million Aussies were insured by an extras policy during the March 2020 quarter. During this same period, insurers paid $705 million in dental cover.[13]

Remember to mind ‘the gap’ when paying for treatment

AIHW’s report also highlights that while more Aussies seek treatment if they had cover, they may face out-of-pocket expenses when they pay for their treatment. These out-of-pocket costs are called ‘the gap’.

The amount you’ll pay on the gap varies, depending on;

  • the level of cover your extras policy provides; and
  • the type of dental treatment you’re receiving.

AIHW shows how the gap can vary, as outlined in the table below:

TreatmentMedian charge for treatmentBenefit (the amount insurers pay towards your treatment)The gap (the amount you pay out-of-pocket for treatment)
Diagnostic comprehensive oral examination$59$40$18
Preventative service (plaque and/or stain removal)$58$38$16
Restorative service (adhesive restoration of one surface of an anterior tooth)$139$72$60
Tooth removal (or part tooth removal)$156$83$76
Full crown$1,500$700$786
Source: Australian Institute of Health and Welfare. ‘Oral health and dental care in Australia’. Updated 31 July 2020. Accessed 4 July 2020.

 

Why are Aussies still paying a gap at the dentist if they have health insurance?

Our health spokesperson, Anthony Fleming, explains that extras policies are designed to contribute towards the costs up to a specific amount for your dental treatment. This amount is outlined in the policy’s Product Disclosure Statement (PDS).

‘The insurer may impose an annual limit on your policy for dental treatment,’ Fleming says. ‘For example, the insurer may offer $800 back on dental services per person per year.

‘Within this limit, your insurer may offer a set benefit amount back or percentage back on your service – like 60% up to a maximum of $800. In the case of 60%, you’d need to pay the remaining 40% for your treatment and anything above the $800 limit. This 40% and above is “the gap”.’

For more major dental treatment, insurers may impose lifetime limits on their policies.

‘For orthodontic work, a policy may cap their rebate at $1,500, for example.’

 

What can Aussies do to help reduce or avoid the dental gap?

Fleming explains some insurers offer no-gap dental, where you won’t need to pay that out-of-pocket expense – but only if you visit a dentist that’s a part of your insurer’s network.

What’s more, Fleming urges the importance of finding an extras policy that offers the level of cover you need.

‘It’s always worth looking around to find an insurer that offers no-gap cover or higher claiming limits – now more so than ever,’ he says.

Six ways to look after your teeth during COVID-19 (and beyond)

1. Get quotes from several dental clinics on typical costs before treatment.

2. Ask if your dentist is offering telehealth appointments. If you’re in a COVID-19 hotspot, call your dentist to see if they’re offering telehealth appointments. According to ADA, these appointments are more suited to those who have just had treatment and have concerns, or for ailments like toothaches or broken or loose teeth.[14]

3. Compare health insurers to find a policy that provides competitive dental cover. Ensure you compare premiums, features (e.g. no-gap dental agreements) and cover limits. Also, keep in mind that most insurers require you to wait two months before you can claim on your extras policy.

4. Try to visit dentists that are part of your insurer’s no-gap dental agreement (if your insurer offers this agreement).

5. Find out if you’re eligible for publicly funded dental treatment. Visit the Department of Health for more information.

6. Try the ADA’s list of low-cost ways to look after your oral health. Some top tips include:

      • brushing your teeth twice daily;
      • spitting excess toothpaste after brushing, rather than rinsing. The toothpaste residue will continue to provide protection; and
      • decreasing your sugar intake. The World Health Organisation recommends no more than six teaspoons per day to reduce your risk of tooth decay.[15]

Sources

[1] Australian Institute of Health and Welfare. ‘AIHW media releases: New data reveals insured patients can still face significant out-of-pocket dental costs’. Released 31 July 2020. Accessed 31 July 2020.

[2] Australian Institute of Health and Welfare. ‘AIHW media releases: New data reveals insured patients can still face significant out-of-pocket dental costs’. Released 31 July 2020. Accessed 31 July 2020.

[3] ADA Victoria. ‘Recent Updates: Dental restrictions’. Last updated 5 August 2020. Accessed 6 August 2020.

[4]Australian Dental Association. ‘“Be a Mouth Keeper”: Looking after your oral health during the pandemic’. Released 5 August 2020. Accessed 5 August 2020.

[5] Australian Bureau of Statistics. ‘4940.0 – Household Impacts of COVID-19 Survey, 29 Apr – 4 May 2020’. Released 18 May 2020. Accessed 23 July 2020.

[6] Australian Dental Association. ‘Australia’s oral health is getting worse … and COVID is not helping’. Released 31 July 2020. Accessed 4 August 2020.

[7] Australian Dental Association. ‘Australia’s oral health is getting worse … and COVID is not helping’. Released 31 July 2020. Accessed 4 August 2020.

[8] Australian Dental Association. ‘2020: Australia’s ORAL HEALTH TRACKER | Technical Paper, Second Edition’. Accessed 31 July 2020.

[9] Australian Government Department of Health. ‘Dental’. Accessed 6 August 2020.

[10] Australian Institute of Health and Welfare. ‘Oral health and dental care in Australia’. Updated 31 July 2020. Accessed 31 July 2020.

[11] Australian Government Department of Health. ‘Child Dental Benefits Schedule: Who Can Get It’. Accessed 5 August 2020 | Australian Government Department of Health. ‘Child Dental Benefits Schedule’. Accessed 5 August 2020.

[12] Australian Institute of Health and Welfare. ‘AIHW media releases: New data reveals insured patients can still face significant out-of-pocket dental costs’. Released 31 July 2020. Accessed 31 July 2020.

[13] Australian Prudential Regulation Authority. ‘STATISTICS: Quarterly Private Health Insurance Statistics. March 2020 (released 19 May 2020)’. Accessed 6 August 2020.

[14] Australian Dental Association. ‘Guidelines for Teledentistry’. Last updated 14 April 2020. Accessed 6 August 2020.

[15] Australian Dental Association. ‘“Be a Mouth Keeper”: Looking after your oral health during the pandemic’. Released 5 August 2020. Accessed 5 August 2020.

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Written by Renee Olsson

Switch coffee for hot chocolate and winter for summer, and that’s Renee. When she’s not glued to the cinema screen, she’s arguing with her fictional characters (it’s a love-hate relationship). Renee studied Creative and Professional Writing and Journalism at QUT and is passionate about inciting positive change through the written word.

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