Does Private Health Insurance Cover Jaw Surgery? 

Find out if orthognathic or jaw correction surgery is covered by private health insurance here through Savvy. 

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, updated on July 10th, 2023       

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Jaw surgery, also known as orthognathic surgery, is a procedure that can be used to correct a variety of jaw-related conditions such as underbites, overbites and jaw misalignment. While this surgery can be life-changing for many patients, it can also be expensive. Therefore, many people wonder if their private health insurance covers jaw surgery.  

Find out what type and level of private health insurance you need to cover jaw surgery here through Savvy and learn about what you need to know about how much Medicare may assist you with the cost of your surgery. 

Does private health insurance cover jaw surgery?

Private health insurance (both hospital and extras cover) may cover some of the costs of your jaw surgery, as long as the surgery is considered medically necessary. If the surgery is purely cosmetic, such as to change the shape of the jaw for aesthetic reasons, it’s unlikely to be covered by private health insurance.  

The level of cover provided by private health insurance will depend on the type of procedure to be performed and the type and level of health insurance which is held.  

Jaw surgery is performed for a variety of reasons, including: 

  • corrective jaw surgery to fix bite problems such as overbite, crossbite or underbite (either maxillary osteotomy or mandibular osteotomy) 
  • surgery to treat jaw fractures or injuries 
  • surgery to remove tumours and cysts 
  • surgery to treat congenital birth defects such as cleft lip and palate, Pierre Robin Sequence or Treacher Collins Syndrome 
  • surgery to treat temporal mandibular joint disorders (TMJ disorders) 
  • procedures to correct obstructive sleep apnoea

There are often three distinct phases involved in operations to fix jaw issues:  

  1. an orthodontic phase, where teeth are straightened and aligned over time with braces or aligners 
  2. surgery, to reposition or reshape the jaw 
  3. following surgery, another orthodontic phase may be necessary to achieve the final accurate result 

Because of these distinct phases involved in jaw surgery, both hospital cover and extras cover may assist with some of the costs of this treatment. Treatments performed at a dental clinic may be covered by extras cover, while the surgery itself (requiring a general anaesthetic and hospital admission overnight or possibly for several days) can come under a hospital cover policy. 

Orthodontics falls under the category of major dental for extras cover, while jaw surgery itself falls under the category of dental surgery for hospital cover. Only silver and gold hospital policies offer dental surgery coverage, so you'll need one of these if you wish to cover jaw surgery performed in hospital. 

Does Medicare cover jaw surgery?

Medicare may provide some coverage for jaw surgery if the surgery is considered medically necessary. However, the coverage provided by Medicare may be limited to hospital admissions and surgery, and may not cover all of the costs associated with teeth alignment and straightening. It’s possible to check online through the Medicare Benefit Schedule if the surgery recommended by your maxillofacial specialist is covered by Medicare.  

Orthodontics usually isn’t covered by Medicare, although if the surgery is considered urgent and medically necessary, a GP may write a referral which enables all treatment to be covered by Medicare.   

If you’re unsure, it's important to speak with your surgeon and health fund to understand what costs are covered under your private health insurance policy and which may be able to be claimed under Medicare.

Frequently asked questions about private health insurance and jaw surgery

Are there waiting periods for jaw surgery coverage under private health insurance?

Most private health insurance policies have waiting periods for major dental procedures, including jaw surgery. The waiting period for hospital cover is usually two months, which means you’ll need to have held your policy for at least two months before you can make a claim for jaw surgery. However, if the jaw condition you suffer from is a pre-existing condition, you’ll have to wait for 12 months before you’re covered. Waiting periods for major dental treatment for extras cover range from two months to 12 months depending on the health fund and policy you choose.  

What is the cost of jaw surgery?

Orthognathic surgery can be costly. The exact cost will depend on several factors, including the complexity of the procedure, the fees of the surgeon performing it and where you have the procedure done. Out-of-pocket costs can range from a few hundred to several thousand dollars. 

What should I do if I need jaw surgery and don't have private health insurance?

If you don't have private health insurance, you may be able to access public hospital treatment for jaw surgery if it’s considered medically necessary and affecting your ability to eat, breathe or sleep properly. However, waiting lists for public hospital treatment can be long, and you may not have control over the timing of your surgery. 

Can I claim the full cost of my jaw surgery on private health insurance?

Most private health insurance policies only cover a percentage of the cost of jaw surgery, with the patient responsible for paying any out-of-pocket expenses or excesses. It's important to check the policy details carefully to ensure that you are aware of the excess which will apply and any co-payment requirements for a hospital admission. 

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