Report on the Second Review of the Dental Benefits Act 2008

Medicare Teen Dental Plan

The Report on the Second Review of the Dental Benefits Act 2008 (the Act) is a further independent review of the operations and administration of the Act, in relation to the Medicare Teen Dental Plan.

Page last updated: 15 May 2012

    The Medicare Teen Dental Plan was introduced by the Australian Government on 1 July 2008 as an election commitment. The program provides financial assistance to families to help assess the health of their teenagers’ teeth, and to introduce preventative strategies to encourage lifetime good oral health habits. The program was enhanced on 1 January 2009 to include additional groups of teenagers. Approximately 1.3 million teenagers are eligible for the program each year, out of a population of approximately 2 million 12 to 17 year olds.

    Under the program, eligible teenagers receive a voucher each calendar year to assist with the cost of a preventative dental check provided in that year The preventative dental check consists of an oral examination as a minimum requirement and, where necessary, x-rays, a scale and clean, fluoride treatment, oral hygiene instruction, dietary advice and/or fissure sealing.

    Preventative dental checks are provided by dentists who are registered with Medicare Australia. The Act makes explicit provision for the preventative dental check to be provided by a dental therapist or dental hygienist on behalf of the dentist. Vouchers can be used at private dental surgeries and public dental clinics participating in the program. In 2008, the voucher provided a Medicare benefit of up to $150 towards the cost of an annual preventative dental check. Indexation is applied to the benefit for item 88000 for each successive calendar year voucher, using the same indexation parameter as Medicare.

    Table 1: Item 88000 voucher value since 1 July 2008.

    Year 2008 2009 2010 2011 2012
    Amount $150.00 $153.45 $157.00 $159.85 $163.05

    Dentists may set their own fees for services, however, the Government has encouraged dentists to bulk bill preventative dental checks for eligible teenagers. Bulk billing for item 88000 has increased over time, and as at the end of September 2011 was 63.9%. Schedule fee observance, which includes bulk billing and private billing for an amount equal to or less than the schedule fee, is high for the item, and as at the end of September 2011 was 94.7%. In the event of either bulk billing or private billing for the schedule fee or below, the patient is not out of pocket; however, a patient who is privately billed may be asked to pay upfront and claim the benefit back at Medicare, which could leave the family temporarily out of pocket.

    Chart 1 demonstrates the bulk billing rates and schedule fee observance rates from the inception of the Medicare Teen Dental Plan, up to September 2011.

Chart 1: Bulk billing and Schedule Fee Observance Rates, from 1 July 2008 to 30 September 2011.