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Medicare Child Dental Benefits Schedule (CDBS)

Overview

Around 3.4 million children aged 2-17 years are able to receive up to $1,013 of subsidized dental services under the Medicare Child Dental Benefits Schedule (CDBS), which replaced the Medicare Teen Dental Plan from 1 January 2014.

The Government introduced this scheme in recognition of the importance of early intervention in the management of dental disease for the long-term health and the well being of patients. Regular dental care at an early age promotes positive dental experiences and establishes a lifetime of good dental habits and routines.

Neglected dental care typically leads to decaying teeth, premature loss of teeth, swollen gums and bad breath. If not treated early, small preventable dental diseases become major and costly dental complications, as well as worsen and promote a host of chronic problems throughout the body, such as:

  • heart disease,
  • stroke,
  • diabetes, and
  • blood-borne infections.

Researchers have also found that women with moderate-to-severe gum disease are twice as likely to give birth to premature babies. Chronic medical conditions can also result in additional admissions in hospitals, which increases health risks to patients, increases public hospital waiting times, and greatly burdens the public health expense in the long term.

Eligibility

A child’s eligibility is assessed at the beginning of each year and lasts the whole calendar year. A child is eligible if they are between 2 to 17 years of age, for at least 1 day of the calendar year. They must also be eligible for Medicare and are either part of a family receiving Family Tax Benefit Part A or one of the following Australian Government payments:

  • Youth Allowance
  • ABSTUDY
  • Disability Support Pension
  • Parenting Payment
  • Special Benefit
  • Carer Payment
  • Double Orphan Pension
  • Veteran’s Children Education Scheme, if the child is 16 or over
  • Military Rehabilitation and Compensation Act Education and Training Scheme, if the child is 16 or over

A patient’s entire $1,000 benefit cap can be used in the first year if needed. If the entire benefit cap is not used in the first year, the balance can be used in the next year if the child is still eligible.

Any balance remaining at the end of the relevant two year period cannot be used to fund services that are provided outside that period. A new benefit cap will become available only if the relevant two year period has elapsed and the child is eligible in a following year.

A patient’s benefit cap can only be used for eligible services provided to that patient – family members cannot share their entitlements.

You can confirm your child’s eligibility and balance amount by accessing your Medicare online account at my.gov.au or calling the Medicare general enquiries line on 132 011. We can also check this on your behalf. Eligibility is based on details held by Centrelink and the Department of Veterans’ Affairs. If your circumstances change and you need to update your family details, you can do the following:

  • if you are a Centrelink customer – access your Centrelink online account at my.gov.au
  • if you are a Department of Veterans’ Affairs customer – call the Department of Veterans’ Affairs on 133 254

Dental services available under the Child Dental Benefits Schedule

The Child Dental Benefits Schedule will cover a range of dental services including examinations, x-rays, cleaning, fissure sealing, fillings, root canals and extractions. Benefits are not available for orthodontic or cosmetic dental work and cannot be paid for any services provided in a hospital.

Child Dental Benefits Schedule services will not count towards the Medicare Safety Net nor the Extended Medicare Safety Net thresholds.

To receive dental services under the Child Dental Benefits Schedule, please call (02) 9871 5228 to make an appointment and let us know your child is eligible for the Child Dental Benefits Schedule. Please also bring your Medicare card with you at every dental visit. At the time of your child’s dental appointment, we will discuss your child’s treatment and any associated costs with you before providing the services. After this has been discussed, you or your child are required by Medicare to sign a consent form.

We will most likely bulk bill Medicare for dental services eligible under the Child Dental Benefits Schedule. If there are any fees or charges to you, we will clearly explain to you before commencing any dental services.

Claiming for services under the Child Dental Benefits Schedule

Please bring your Medicare card with you at every dental visit, as we can electronically claim this directly to Medicare. If you forget to bring your Medicare card you must pay for the treatment, then manually claim back the eligible benefits from Medicare.

Manual claims can be done:

  • by downloading the Medicare claim form and posting it to the Department of Human Services, GPO Box 9822 in your capital city, or placing it in the drop-box at one of their service centres
  • in person at your local Medicare Service Centre
  • by calling 132 011

We cannot claim a benefit:

  • under the Child Dental Benefits Schedule and from a private health insurer for the same dental service
  • for dental services performed on another family member who is not eligible for the Child Dental Benefits Schedule.

Further information

If you would like further information about the Medicare-funded dental services, please:

  • visit the Department of Health and Ageing’s website at www.health.gov.au/dental;
  • call the Medicare Australia Patient Enquiry Line on 13 20 11; or
  • call Carlingford Dental Surgery on (02) 9871 5228 for a free consultation.