Smile! Medicare can now help with your dental expenses

As part of the ‘MedicarePlus’ program announced by the federal government in March, Medicare reimbursement is now available in some circumstances for ‘allied health services,’ including dental treatment.

Good oral health is important for everyone, and can be of critical importance for people with HIV. Dental decay, gingivitis [1]Inflammation of the gums (the gingiva) caused by poor oral hygiene. Chronic gingivitis can worsen to become periodontal disease. and periodontal disease, while they can affect anyone regardless of HIV status, can create significant problems for positive people.

Some antiviral [2]A medication or substance which is active against one or more viruses. May include anti-HIV drugs, but these are more accurately termed antiretrovirals. and other medications can cause dry mouth, which can exacerbate dental decay, while gingivitis and periodontal disease can be more aggressive and difficult to treat in people with compromised immune systems. Additionally, positive people (especially those with low CD4 counts) may develop a very rapid form and severe form of gingivitis called linear gingival erythema (LGE), which is unrelated to dental hygiene. Untreated, this can lead to a painful condition called necrotising ulcerative periodontitis [3]Disease of the tissues that support the teeth, including the gums, the periodontal membrane and the underlying bone. Periodontal disease, which includes gingivitis and the more serious periodontitis, is the most common cause of loss of teeth in adults. People with HIV/AIDS are at increased risk of developing periodontal disease, even with good oral hygiene. (NUP).

Any of these conditions can lead to reduced appetite and nutritional problems, which can have a major effect on your overall health.
For these reasons, the inclusion of dental treatment in the Medicare system is a welcome change. So how do you take advantage of the new arrangements? Can you just go off to your local dentist and hand over your Medicare card?

Unfortunately, it’s not that simple. The new arrangements for allied health services apply only to people with complex, chronic or terminal medical conditions who are receiving treatment under the Enhanced Primary Care (EPC) program.

The EPC program, introduced in 1999, enables medical practitioners to develop care plans for their patients incorporating the services of at least two ‘allied health professionals’. As well as dentists, care plans can involve Aboriginal health workers, audiologists, dietitians, mental health workers, occupational therapists, physiotherapists, podiatrists, chiropodists, chiropractors, osteopaths, psychologists and speech pathologists.

The idea is to create a multidisciplinary team approach to treat people with complex medical conditions.

In order to qualify for the Medicare rebate, allied health services must be included in an EPC plan drawn up by your treating doctor in consultation with the other allied health professionals involved. If you have specific dental problems which are affecting your general health, your doctor can include a dentist in the plan, and you can then access the rebate.

The EPC program is specifically intended to deal with people who are ‘complex cases’, so while HIV/AIDS certainly fits the description of a complex chronic condition, whether or not an EPC plan is right for you is a decision your doctor has to make, in consultation with the other practitioners included in the plan.

The new arrangements are not means-tested, but there are limits to the amount of money you can claim back from Medicare and it’s unlikely that the rebates will cover the full cost of a course of treatment. For dental care, the maximum you can claim in one year is $220, for up to three consultations.

For other allied care services, the rebate is up to $80 for the initial consultation, and $35 per consultation thereafter, up to a maximum of five consultations (including the initial visit) per year.

If you’d like to find out more about this, speak to your doctor.