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:
- an orthodontic phase, where teeth are straightened and aligned over time with braces or aligners
- surgery, to reposition or reshape the jaw
- 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
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