Orthodontic treatment can be a significant investment. The good news is many private health funds offer rebates for braces and other treatments. But not all policies are the same.
Here are some key principles to help you understand what’s typically covered. For exact details, check with your health fund.
This article provides general information only. Please check with your private health fund for the most up-to-date details, as inclusions and rebates may change.
How Private Health Insurance Covers Orthodontics
Orthodontic treatment usually falls under extras cover. But not all extras policies include it.
There are three common categories in dental extras:
- General dental (e.g. check-ups, cleans)
- Major dental (e.g. crowns, root canals)
- Orthodontics (braces and related appliances)
Some funds bundle orthodontics with major dental. Others list it as a separate category. If your policy includes orthodontics, it’s likely to offer a percentage rebate on treatment costs, up to a certain limit.
What’s Typically Covered?
Each fund is different, but most will include:
- A percentage rebate, often between 50%–80%
- An annual limit and/or a lifetime limit
- A 12-month waiting period before claiming
Many policies have a lifetime limit for orthodontics (e.g. $2,000–$3,000 per person). Once this is used, no further rebates apply. Others reset annually but with lower caps.
Coverage can vary based on your level of cover and how long you’ve been a member.
Tips to Maximise Your Rebate
- Check your waiting period
Most funds require you to serve 12 months before claiming orthodontic benefits. - Plan around the calendar year
Annual limits often reset on 1 January. Starting treatment late in the year could let you claim across two years. - Ask for a detailed quote
Dr Ronny Marks provides itemised quotes that make it easier to confirm your rebate with your fund. - Consider family policies
Some funds offer combined family limits or enhanced cover for dependants.
What Braces and Appliances Are Included?
If your policy includes orthodontic cover, it usually applies to:
- Traditional metal braces
- Ceramic (tooth-coloured) braces
- Retainers and review appointments
Some funds also cover clear aligners, but this varies. Always confirm before starting treatment.
What About Early Treatment for Kids?
Some children benefit from early orthodontic intervention. Treatment like expanders or growth modification appliances may qualify for rebates under orthodontics cover.
Early assessment is important. The Australian Society of Orthodontists recommends children see an orthodontist between ages 7 and 10.
Learn more about Early Interceptive Orthodontic Treatment
Are Braces for Adults Covered Too?
Yes. Private health funds don’t limit orthodontic cover by age. If your extras policy includes orthodontics, you’re eligible for rebates whether you’re 14 or 40.
Orthodontic treatment for adults often involves more detailed planning, so accurate quotes and timelines are important.
See options for Adult Orthodontic Treatment
FAQs
How do I know if my policy includes orthodontics?
Contact your health fund. Ask if orthodontics is included, what the limits are, and if any waiting period applies.
What if I already started treatment?
You usually need to serve the waiting period and have cover in place before treatment begins. Retrospective claims are often not allowed.
Can I claim on both Medicare and private health?
Medicare generally does not cover braces. Private health is the main rebate option for orthodontics.
Can I use a health savings account or gap-only option?
Some funds and clinics offer gap cover or HSA-style payment options. Ask your provider.
Speak With Your Health Fund – And Your Orthodontist
Every policy is different. Coverage depends on your level of extras, waiting periods, and annual/lifetime limits.
At your consultation, Dr Ronny Marks provides detailed itemised quotes. These can be used to confirm rebate amounts with your fund before starting treatment.
