Looking for health insurance to cover orthodontics? Receive up to $3,000 per year.
Being blessed with perfect teeth is something we all want, but unfortunately not everyone can smile when speaking about their own. If you fall into this category, you’re likely to end up visiting an orthodontist. This is a specialist who can prep you for that perfect picture by straightening your teeth and jaw.
Orthodontic treatment generally involves the design and use of corrective appliances like braces and retainers, but can be expensive without the right combination of private health cover.
Compare health insurance for orthodontic treatment from 30+ funds
What type of health insurance do I need to claim for orthodontic treatment?
Orthodontics isn’t usually covered under your health care insurance, so it's vital you understand what extra policy options you will need to take out.
Orthodontic insurance may be included in your dental insurance, but it’s usually an add-on cost.
There are the two types of dental insurance cover.
- General Dental. This includes cleaning, plaque removal, x-rays and small fillings.
- Major Dental. This covers orthodontic treatment and procedures, wisdom teeth extraction, crowns, bridges and dentures.
What is covered by the funds in the finder.com.au panel?
| Health fund | Which policies include cover for orthodontics and what are the benefit limits*? | Find out more |
|---|---|---|
 | The orthodontic benefit limit in HIF policies is a lifetime limit that form part of the overall annual limit. The limit also increases annually and caps after five years.
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| Australian Unity |
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 | The orthodontic benefit limit in GMHBA policies start increasing after three years of holding cover with the amount capping after year ten.
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 | Annual and lifetime limits are increased if you visit an HCF More for Teeth provider.
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 Restricted fund** |
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*Unless otherwise stated all benefit limits are per person.
| Health fund | Which policies include cover for orthodontics and what are the benefit limits*? | Find out more |
|---|---|---|
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| Australian Unity |
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| Bupa |
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| The orthodontic benefit limit in GMHBA policies start increasing after three years of holding cover with the amount capping after year ten.
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 | GMF orthodontic benefit limits increase after five years and finally cap at ten years.
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 | Please note that orthodontics and implants share a combined benefit limit.
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| Annual and lifetime limits are increased if you visit an HCF More for Teeth provider.
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| The orthodontic benefit limit in HIF policies is a lifetime limit that form part of the overall annual limit. The limit also increases annually and caps after five years.
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 Restricted fund** |
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 Restricted fund** |
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 Restricted fund** |
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 Restricted fund** |
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 Restricted fund** |
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 Restricted fund** |
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 Restricted fund** |
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 Restricted fund** |
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*Unless otherwise stated all benefit limits are per person.
**Restricted funds only provide cover to members of specific industries, groups and organisations. In some cases family members may also be eligible to join.
Benefit limit terms explained
- Sub-limit. A sub-limit is the largest possible amount you can claim for a specific service, which is then deducted from a larger overall benefit limit. For example, your dental cover might include an overall benefit limit of $900 with sub-limits of $300 being applied to bridgework, endodontics and dentures. In this case, the maximum you could claim for any one of those services is $300.
- Shared or combined benefit limit. This means that the benefit limit is shared amongst multiple services, rather than applying a limit to each one individually. While you are not restricted to claiming a capped amount like you are with sub-limits, your total overall benefit amount is spread over a wider range of treatments, so be sure not to claim excessively on one service and leave yourself without cover for others.
- Lifetime benefit limit. This is the maximum amount you can claim for a service throughout your lifetime. Be aware that if you've reached your lifetime benefit limit with one fund and switch to a new one, they may deduct that amount from your new policy. It is recommended that you check with your new fund to find out if these penalties apply.
Does dental insurance cover braces?
How much do braces cost in Australia?
The fee you will have to pay for braces varies greatly depending on the types of braces you require and the scope of the dental issues they are used to correct. However, as a general rule you can expect to pay anywhere from $2,000 up to around $9,000 for braces in Australia.
How does health insurance cover braces?
If you want health insurance cover for the cost of braces, you’ll typically need a high-level extras policy that includes cover for orthodontic treatment. The exact level of cover provided varies depending on the health fund and policy you choose, as annual limits and also lifetime limits apply to the cover available.
How much does Invisalign cost in Australia?
Invisalign is a hygienic and almost invisible way to straighten teeth. However, it tends to be more expensive than conventional braces. While costs vary depending on the complexity of your dental problems and your orthodontist’s consultation fees, costs generally range from $6,000 up to $9,000.
How does health insurance cover Invisalign?
If you have an extras cover private health insurance policy that includes orthodontics, your Invisalign treatment may be covered to the same level as traditional braces. However, it’s best to confirm the extent of cover available with your fund and check any annual or lifetime limits that may apply.
What should I do if I need to claim orthodontic treatment?
Before you can start reaping the benefits from your orthodontic insurance, you’ll need to make a claim. To do this you’ll need to ask your specialist for a “treatment plan”. This will determine how long the procedure could take and how you intend to pay for the cost of the treatment.
Once you have this information you can send it to your fund to see what benefits, if any, you’re eligible for. There are two options to start claiming benefits through your health fund. You can either pay by instalments or up-front.
- Paying by instalments. Here your dentist or orthodontist can process your claim on the spot by swiping your HICAPS (Australia's leading health claims and payments service) card.
- Paying up-front. If you choose to do this, you’ll need provide your fund with a tax invoice to claim benefits for the procedure.
What types of treatments are performed by orthodontists?
An orthodontist offers a range of procedures inside the mouth to help straighten your teeth or jaw. Problems are often found in young patients under the age of ten but issues can also be found much later in life.
These procedures can include the following.
- Treatment assessment. Here your orthodontist or specialist will talk about what treatment is needed before making arrangements to begin.
- Extractions and teeth removal. This is a preliminary procedure where your orthodontist will remove teeth to gain sufficient space to align remaining teeth.
- Braces. This is the most efficient and accurate way of moving teeth and includes bands, brackets and wires, which are usually made of stainless steel.
- Rubber bands and headgear. This accompanies your braces and gives important extra forces for the correction of the bite.
- Length of treatment. Usually takes 18 - 24 months. Some cases may be finished earlier and others may take longer.
- Check-ups. This is an ongoing cost and will see your specialist regularly inspecting how the treatment has gone and if it has worked.
- Retainers. This is when your braces are removed and retainers are fitted to hold your teeth steady in their new position. These appliances may be removable plates or wires fitted behind the teeth.
Why is orthodontic treatment expensive?
Orthodontic treatment can impose a major financial burden, because problems and procedures can be extremely complex. They also require expensive equipment to get the job done, like the cost of having an X-ray and imaging equipment, along with regular check-ups and orthodontic adjustments.
What information do I need to ask my dentist or orthodontist for?
You should ask your dentist or orthodontist the following questions before you begin treatment to straighten your teeth or align your jaw. Here are some questions to think about.
- What is the total cost of your treatment? You must be aware of the full cost and how you will pay for it.
- Is there a timeframe for your active treatment procedure? This is when your teeth are still being moved as opposed to them being retained (kept in place).
- What item numbers will apply? This will give some insight into the cost and what procedures will take place. It will also include your dentist or orthodontist’s provider number.
How do limits and waiting periods apply to my policy?
Benefits differ between private health funds. Before they start you will in most cases have to serve a 12-month waiting period before you see any financial benefits returned. There are a number of private funds that will maximise your benefits the longer you are with them. This gives you an incentive to stay with that fund.
Here’s an example of an accrued benefit based on a policy with a starting limit of $500, which then increases by $200 every year after you have served the initial 12 month waiting period.
- 1st year - $500
- 2nd year - $700
- 3rd year - $900
- 4th year - $1100
Under this arrangement, your annual benefit will continue to increase until you reach the maximum benefit, or what is known as a “Lifetime Limit”. It is important to note that not all health funds have accrued benefits. Instead, some pay a fixed benefit each year.
What if my orthodontic treatment is provided by a general dentist?
Normally your fund will give the same amount of benefit back whether you see an orthodontic specialist or a general dentist. However, in some cases your fund may pay a lower benefit if you see a dentist, so it’s important you speak to your fund about this.
Can I claim orthodontic treatment on my tax?
You can claim orthodontic dental work on your tax reform, but you must determine it to be more than ‘solely’ cosmetic surgery.
For example, if you have your teeth extracted and braces put on to help with crowded teeth, or your jaw aligned to help you chew or swallow properly - you can claim this on your tax return. You won’t qualify if you have your teeth whitened because of smoking stains.
The Australian Tax Office lumps dental expenses together with other medical expenses, so you can’t claim back every dollar you spend, but there are certain rebates to be mindful of.
If you have more than $2060 in total medical expenses (your total medical expenses minus Medicare and private health rebates) within one tax year, you can claim 20% of the amount above the total, as a deductible expense.
Learn more about how private health insurance is taxed
What happens to loyalty limits when I change health funds?
If you change health funds, your accrued benefits may not be carried over unless your fund agrees, but this is rare. In most cases, your benefit is not transferable and it could be lost if you switch funds. This could see you forced to start at the base benefit with your newly chosen health fund.
Compare private health insurance policies and quotes from multiple funds
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