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Do Health Funds Cover Dental Implants?: Your Guide to an Affordable and Healthier Smile

Dental implants offer long-term solutions to address tooth loss and improve quality of life. Dental implants are false teeth, but their popularity has grown to improve dental health. Your dental health is vital to determine if you are a good candidate for a dental implant. 

Are you considering getting dental implants but worried about the cost? We understand finances are a consideration when making healthcare decisions.

This blog post will explain what is involved with dental implants and whether health funds cover dental implant surgery costs. You’ll learn to save thousands of dollars on this procedure from regaining your beautiful smile and healthy teeth. Read on for all the essential details!

  • Dental implants offer a long-term solution for tooth loss and improved quality of life

  • Health funds may partially or fully cover dental implant costs, depending on the provider and policy

  • Types of health funds include gap-free dental cover, limit-free dental plans, annual member perks, and personalised dental care coverage

  • Contact your health fund provider to determine what exactly they cover for dental implants and if there are any waiting periods

  • Dental implant costs may be reduced through health funds, but coverage varies between companies and policies

  • Other payment options for dental implants include early super release, Child Dental Benefits Schedule, DVA cardholder benefits, and HICAPS

  • Medicare does not cover dental implant costs in Australia.
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Do Health Funds Cover The Cost Of Dental Implants?

The short answer is, It depends. Health funds are becoming popular for many to access the dental care they need and deserve. Since implants can be expensive, exploring health funds is an option. Depending on your provider, health funds may provide the total or partial amount. As a rule of thumb, it pays to be diligent and know what your policy covers and what it does not. Generally, dental implants will not be covered by dental insurance. Yet, some health funds cover this as part of your policy.

You can avail of different financing options depending on the service type. Below are common types of health funds that may cover major dental implants as a solution or alternative for patients:

  • Possible Gap-free Dental Cover
    Gap-free benefits are applied when you commit to an eligible health fund as part of your dental plan, allowing for up to 100% reimbursement for selected services, covering the fees charged by your dentist to improve your teeth.

    If you have a health fund that includes a gap-free dental cover, you may request reimbursement of the entire cost of your dental implant. The health fund may cover major dental implants, teeth cleanings, dental crowns, and artificial replacement teeth. The health fund may also cover artificial tooth crowns, permanent tooth replacement procedures, complete dentures, conventional dentures, and other complex procedures to improve teeth structure.

  • Limit-free Dental Plans
    Many health fund providers offer a limit-free dental plan to their clients. In this plan, clients are given an annual limit or a threshold of what the health fund covers for teeth implants, dental bridges, dental treatments, dental procedures, primary dental services, and other surgical procedures. The client must pay for the excess amount when this fund is exhausted. You must secure the consent of the health fund provider to waive the cap or threshold if necessary. The approval varies from patient to patient, depending on the circumstances.

  • Annual Member Perks
    Some health fund providers offer annual member perks for their clients. These perks include free dental check-ups, teeth cleaning, and major dental services for your teeth to look like natural teeth. Major dental services may consist of tooth implants. Many become members to avail of particular plans that are attractive options to patients needing dental care.

    Personalised Dental Care Coverage

    Depending on your policy, your health fund provider has predetermined what dental services you can avail of. Some policies include dental implants while others do not, so this is a patient-to-patient basis.

How to Check if My Health Fund Cover Dental Implants?

You should contact your health fund provider and inquire whether they would cover or contribute to your dental implant cost. It’s essential to understand the details of your health fund when figuring out what kind of treatment for your teeth it will be able to pay you. When you check with your health fund, you should also include clarifying any waiting periods that may be required. Doing this will enable you to prepare better. It’s important to check as inclusions differ among health fund providers and policies, so you must talk to your provider.

Additionally, you can review your health fund policy or seek advice from a dentist who can provide further insight. Your dentist may have information relevant to what your health fund may cover on dental services to improve your teeth. Doing the necessary research beforehand will give you peace of mind and help you make informed choices.

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What is the Process of Using Health Funds For Dental Implants

  1. Contact your health fund provider.
    First, you must ensure that your health fund provider covers dental services like dental implants. It would be best to call a customer representative to determine whether your policy includes payment for dental services such as dental implants. After you discuss it with them, they will tell you how much you can receive as reimbursement.

  2. Schedule a consultation with your dentist.
    As a next step, you must schedule a consultation with your dentist to discuss the procedure and costs of the dental implants. Your implant dentist will tell you how much you will need to prepare.

  3. Submit a claim for reimbursement from your health fund provider.
    Once you determine how much your dentist charges for your procedure, you can submit a claim for reimbursement. Your health fund provider will assess how much of the total bill will be covered by your health fund, depending on your policy.

  4. Wait for approval by your health fund provider.
    You have to wait for the go signal of your health fund provider to assess how much will be covered for your dental implant procedure. Your health fund provider will issue a pre-authorisation before your dental implant procedure. Before the procedure, you will know the amount that will be reimbursed and the amount you should prepare to contribute to the treatment.

What is Covered Under Health Funds When it Comes to Dental Implants?

Health funds provide different levels of services covered depending on which policy you have selected and can help to reduce the out-of-pocket expenses for expensive major dental procedures such as dental implants. Some health funds cover 50% of the total fees, and some do not cover anything at all. Before undertaking teeth procedures such as dental implants, check with your health fund provider about what is covered under your policy to know what costs will be needed up-front and how much money you can expect to be reimbursed.

It is important to remember that every individual’s case is unique; thus, what patients receive may not reflect the same level as their fellow patients.

What Are The Exclusions of Health Funds When it Comes to Dental Implants?

The extent of your dental implant health fund cover will depend on the terms and conditions of your policy. It’s important to note that some health fund providers impose rules and restrictions on dental implants. Health fund exclusions and regulations on dental implants may include conditions such as having pre-existing teeth conditions that need a high cost for replacement.

How Do Health Funds Affect the Cost of My Dental Implants?

Health funds are a great option to consider when looking at the cost of dental implants. Health funds may cover preventative and restorative dental treatments for your teeth. Health funds may cover consultations, treatment plans, fillings, crowns, dentures, bridges, artificial tooth replacement, and artificial tooth roots. Health funds may also cover root canal treatments, single tooth extraction, and implant surgery costs. 

Health funds can help reduce the out-of-pocket costs for those needing dental implant treatment that may be too expensive for them. It’s important to note that all health funds differ, so what is claimable will vary between companies and policies. You may have your dental implant covered under health funds if your policy includes these services.

How Much Will a Dental Implant Cost?

The cost of a dental implant can vary depending on the extent of treatment required and the materials used. Generally, the average cost of a single implant is around $4,000 to $6,000. You may have your dental implant covered under health funds for a specific amount as long as the dental implant surgery cost is included in your policy.

What Other Payment Options Are There For Dental Implants?

Different financing options allow you to afford implant surgery costs depending on the service type. Clinics offer flexible payment options. Some of the payment plans are found below:

  • Health Funds
    Health funds vary in terms and conditions, so research what is available for your situation. You may have your dental implant covered under health funds if eligible. Some health insurers also provide specific discounts and rebates to patients for services that may reduce the cost of dental implants. Securing health funds that cover discounts or refunds for dental implants is a beneficial option.

  • Early Super Release
    The Early Release of Superannuation (ERS) scheme is a program of the Australian Government that allows you to maximise your superannuation to pay for dental care. This initiative enables implant patients to have the cost of their dental implant covered in whole or in part. Be informed that the process of applying for this for dental procedures may be tedious and the process for approval can be strict.

  • Child Dental Benefits Schedule
    The Child Dental Benefits Schedule is an Australian Government initiative that aims to help improve the oral health of eligible children patients. The program covers dental treatment for children’s primary teeth services. Unfortunately, the benefits exclude orthodontics or cosmetic dental procedures.

  • DVA Card Holders
    The Department of Veterans Affairs issues cards that give you access to certain benefits depending on the card type or colour. Some cards are eligible for discounted health care and dental treatment. Some cards’ benefits include the cost of dental implants and other teeth services.

    HICAPS stands for Health Industry Claims and Payments Service. HICAPS is an electronic health claims system allowing members to claim at their health service provider on the spot. Since this process is immediate, you can expect to receive the benefit you are eligible for on the day of your dental treatment; thus making it popular as a preferred option. You can apply for your claims faster and more through this method.

Does Medicare Cover the Cost of Dental Implants?

No. Medicare currently does not cover dental implants in Australia. If someone needs a dental implant, they will have to bear the cost of dental implants. Health funds may help cover some costs, depending on the policy.

Final Thoughts

With the proper knowledge, having dental implants can be more affordable. Health funds may be able to cover dental implants, but those who are not eligible may still have other options. Make sure to consult your dentist and do some research on all the options that are available before making a final decision. As always, it’s important to remember the value of good dental care and stay informed to have healthy teeth. Do your research and find the best possible route to finance them. Everyone deserves healthy teeth and a beautiful smile to improve their quality of life!

If you want to talk to a dentist and know if dental implants are right for you, book an appointment with us at South Perth Dental Surgery.

Call Us Today to Schedule Your Dental Appointment

South Perth Dental Surgery has been providing high-quality dental care to families for over 30 years. Our team of experienced dentists offer extensive world-class services and stays current with the latest dental technology so we can help keep your smile looking great.
Make an appointment with us today and see what we have to offer!