Do you need to upgrade your health insurance?
We know that the cost of living is squeezing budgets from every direction. So, it’s no surprise that people are sitting down with their health fund’s comparison table and reassessing their extras cover.
For some, the question is “Should I upgrade my extras cover?” while others are asking themselves: “Do I even need extras?”. Both are fair questions, and we’ll do our best to answer them in a general way, because we know individual circumstances vary.
Let’s put it this way: upgrading your extras cover won’t automatically mean better dental health, so consider what the extras cover actually provides that’s “extra”.
The extras cover model doesn’t suit everyone
If you’re on a basic extras policy and upgrade to gold or top extras, it’s only natural that you think you’re better placed. After all, you have higher annual limits, a longer list of covered items, and a sense that you’re being proactive, thoughtful, and responsible about your health.
What the brochure doesn’t explain is the model that sits behind many of those policies.
High-volume, bulk-billing dental clinics are built around the rebate system. They see as many patients as possible, maximise the item numbers that attract rebates, and keep chair time short. That’s not a criticism, simply the economic logic of the model. If a practice is structured around throughput, then treatment decisions are shaped by that sensibility.
From a patient’s perspective, what that higher premium actually provides might be little more than access to that volume: more claimable items and more rebate dollars.
When it comes to major dental treatment, including braces, clear aligners, crowns and implants, there’s often no significant difference in your rebate, whether you use a health fund’s “preferred provider” bulk billing clinic or an independent practice like Middleborough Dental Care.
The bottom line is that paying higher premiums for extras cover doesn’t necessarily equate to better care, more time with your dentist, or more dollars coming back to you in rebates.
What “better” actually looks like
Good dental care is slower and more considered than most people realise.
A dentist should spend time understanding your full medical history, track that with you, and make you feel that you’re working together for your general as well as dental health outcomes.
At Middleborough Dental Care, we believe most patients want a dentist who explains what they’re seeing before they reach for an instrument. One who discusses your options rather than proceeding as if you’re just a passive bystander in your own treatment. And especially one who schedules you for the time your appointment actually requires, not the minimum needed to keep the books ticking over.
That kind of care is harder to find inside a rebate-maximising framework. But, perhaps more importantly in this context, it often doesn’t cost dramatically more out of pocket, especially once you factor in the difference in premiums.
Questions worth asking before you decide to upgrade
Before you click “upgrade policy”, it’s worth running through a few things:
What do you actually use?
Pull your claims history from the past two or three years. If you’re mostly claiming for check-ups, a clean and the occasional X-ray, a basic policy may already cover what you need. Paying for orthodontic limits you’ll never use isn’t a bargain.
What you’re paying in premiums vs. what you’re claiming
This maths is often unflattering. Many people are paying hundreds more per year in premiums than they ever recover in rebates. The fund isn’t losing money on you (by design).
Does the policy restrict where you go?
Some extras policies incentivise you, either financially or structurally, to use preferred providers. That’s worth knowing before you sign up, because it limits your ability to choose based on quality.
What does your dentist actually recommend?
A dentist who knows your mouth and your history is far better placed to tell you what level of care you’ll need over the next few years than a health fund’s marketing team.
What matters more to you?
Would you rather pay for quality dental care at a practice you trust and choose? Do you want to choose your dentist the same way you choose any other specialist: based on skill, communication, and values, rather than who they have a commercial arrangement with?
We’re here to help
We understand that many people are making very pragmatic decisions at the moment. The cost-of-living pressure is real, and it absolutely makes sense to be strategic about what you’re spending.
In the case of extras cover, this means stepping back and asking whether the premium increase is actually buying you better care, or just a higher rebate on the same volume-based treatment.
Because we’re talking about insurance, there’s also an element of precaution involved. What if your current needs change significantly? Is it better to be safe than sorry? Is spending a bit more “just in case” preferable to potentially being caught short?
If you’re not sure about what you actually need, that’s a conversation the Middleborough Dental Care team is genuinely happy to have. We can talk through your dental history, what we’d expect over the coming years, and whether your current cover (or no cover at all) makes sense for your situation.
Please don’t hesitate to let us know if you need our input. We’d much rather know that whatever you decide to do has come after weighing up your situation, rather than following what someone else has said or done.
Meanwhile, now’s the time to check whether your dental limits reset on July 1 (some funds follow the calendar year and others the financial year). If so, make the most of any remaining benefits for this financial year by booking in for a check-up this month.