Medicare Benefits Scheme

Medicare Benefits Scheme or Primary Care Plan is an initiative from the Australian Government, which was introduced in November of 2007. Eligible patients will be able to receive up to $4250.00 in Medicare benefits (Including extended Medicare Safety Net benefits where applicable) for dental services over two consecutive years. To be eligible, a patient must meet certain eligibility criteria and be referred by their GP to us.
It is up to the General Practitioner to determine whether a patient is eligible for referral to us with reference to the following criteria.

Firstly, a person must:

• Have a chronic medical condition and complex care needs; and
• Their oral health must also be impacting on, or likely to impact on, their general health.

Residents of aged care facilities can also be referred for dental services under Medicare. Again, certain criteria and specific “Medicare item numbers” must have been lodged within the last 2 years for these patients.

Secondly, the patients GP must refer the patient to the dental practice. There is a specific form which the GP will fill out and the patient must bring this to us. When you visit your GP, they will usually ask you if you have a preferred dentist, you can tell them it is us.

Chronic medical conditions and complex care needs

A chronic medical condition is one that has been or is likely to be present for at least
6 months including, but not limited to, asthma, cancer, cardiovascular illness, diabetes mellitus, arthritis, mental illness, musculoskeletal conditions and stroke.

We will always give you a written quote prior to commencing treatment to help you to understand the exact cost of treatment.

In this instance, Medicare is like a generous health fund. Medicare will only pay a set amount for each item number, regardless of how much of the $4250 you are eligible for. For example, a comprehensive dental examination is $65.00 here at Churchill. The item number for this treatment (which Medicare will associate with a comprehensive examination) is 85011. Medicare will pay $40.50 of this, meaning that the “gap”
would be $24.50.

For more information and contacts you can call us directly on 96968777 or for Medicare related general enquiries you can call 132 011 or visit www.medicareaustralia.gov.au