Medicare rebate for Dental service
Under the Medicare chronic disease dental scheme, Medicare benefits are available for most services provided by a dentist, dental specialist or dental prosthetist in private dental surgeries. The Medicare chronic disease dental scheme allows chronically ill people who are being managed by their GP under an Enhanced Primary Care (EPC) plan access to Medicare rebates for dental services.To receive a Medicare benefit for dental services, patient will first need to meet certain eligibility criteria and be referred by their GP to a dentist. In some cases their GP will refer them directly to a dental prosthetist for denture work.
Who are eligible for dental services under the Medicare chronic disease dental scheme?
To be eligible to claim the rebate for dental service , patient must have a chronic medical condition and complex care needs and their oral health must be impacting on, or likely to impact on, their general health.
A chronic medical condition is one that has been or is likely to be present for at least six months. It may include, but is not limited to, conditions such as asthma, cancer, cardiovascular illness, diabetes mellitus, arthritis, mental illness, musculoskeletal conditions and stroke.
Complex care needs means that your patient is receiving ongoing care from a multidisciplinary team, which includes their GP and at least two other health care providers.
In practice, this means the patient will need to be managed by their GP under certain care plans. For most people this involves the preparation of a GP Management Plan and Team Care Arrangements. For residents of aged care facilities, it involves the GP contributing to a multidisciplinary care plan prepared for the resident by the facility. Patients should talk to their GP about whether they are eligible for these plans. If they are eligible their GP must complete the plans and bill them before the patient has their first dental service.
Once your patient has been referred by their GP to a dental practitioner, the patient can call Medicare Australia on 132 011 to check that the necessary GP care planning items have been claimed and paid before starting dental treatment, even where their GP has signed a referral form. If the relevant items have not been claimed and recorded, Medicare Australia cannot pay benefits for dental services.
A comprehensive range of dental services will be covered, including dental assessments, preventive services, extractions, fillings, restorative work and dentures. The primary purpose of the dental treatment must be to improve oral health or function. Medicare rebates will not be paid for dental services that are purely cosmetic in nature. Under the Medicare chronic disease dental scheme, Medicare rebates cannot be claimed for dental treatment provided by public dental clinics or where the patient is an in-patient (i.e. an admitted patient) in a hospital.
How to claim dental services under Medicare?
Patients can claim Medicare benefits for dental services in the same way as other Medicare services (e.g. by visiting a Medicare office to claim a rebate). For more information about the Medicare dental services, go to the Department of Health and Ageing website.
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