How to Break Even on Extras Cover

Jatacid on 19/03/2022 - 11:16

I've never had extras insurance because I could never justify breaking even. It seemed in order to break even you have to spend more than you would otherwise.

But next year, I want to do some major aesthetic dental work. Estimated to be about 4-5K!
I'm trying to find extras cover that I can sign up now so that the waiting period is met.

But I don't know how to find one that's gonna be good value.

Most of them have a cashback of 50% or 60% which is less of an issue, but all of them have a max limit back of $500-$1000.

The ones that have a higher limit back seem to cost thousands of dollars a year, almost completely negating the whole point of it.

How are you supposed to get money back on a big procedure? What's the best option?

Thanks!

Health & Beauty Health Insurance Insurance

Comments

  • SF3 on 19/03/2022 - 11:24
    +12

    How to Break Even on Extras Cover

    This is a reason why our health insurance premiums goes up…

  • Muzeeb on 19/03/2022 - 11:39
    +1

    aesthetic dental work.

    Is that even covered?

    • brendanm on 19/03/2022 - 11:43
      +5

      And if so, does the cost remotely justify what you get back? I suggest it's probably no, and no.

      • jackary on 19/03/2022 - 14:54

        You are correct fine sir

  • USER DC on 19/03/2022 - 11:43
    +8

    best way is to not get it at first place. Insurance is just a bloody donation most of the times

    • Benoffie on 19/03/2022 - 12:15
      +1

      Agree. There is no way to break even on Extras and if there were, what would be the point? Just pay for it.

      • Jatacid on 19/03/2022 - 14:53

        Why do the majority of people have private health insurance/extras then?

        • jackary on 19/03/2022 - 14:55
          -1

          Majority? Source?

        • USER DC on 19/03/2022 - 16:02

          Because they cannot manage their finances properly e.g.
          They will pay insurance of 20$/ month for 10 months easily instead of saving like $15/month for emergency spending.

          And that $20/month donation can help them get a cover of like $1000 but they still have to pay a initial claim fee of like $200+ or something idk,

          So yea (for healthy people) if they can manage their finances properly, they dont need premium insurance etc

          If someone is at very high risk of something, and insurance somehow allows to cover them, they may take it cause of being at super high risk.

  • mrklaus on 19/03/2022 - 11:45
    +1

    Don't get me wrong but you are trying to beat them at their own game.
    Health insurance is the insurer betting against your odds of needing a payout of some sorts, so while individually you might be able to break even like you said (under very specific circumstances, if any tbh), their plans are carefully laid out so they won't "lose".
    That's the nature of insurance from the perspective of an insurer. :)

  • apsilon on 19/03/2022 - 11:52
    +1

    There's no way you're getting $4k+ back in one year from one procedure. They're all capped for max claim per procedure per year.

  • harveyworld on 19/03/2022 - 12:20
    +1

    Take a trip to Thailand and get a holiday out of too.

    Do your research but there are many good dentists out there who will correspond with you and discuss costs and processes before your travel.
    Many of the technicians have been trained in Australia so read/research references and customer reviews.

    My wife had some major dental work done a few years ago and the quality and service was just superb.

    The money we saved paid for the 2 week holiday and some.

    • Jatacid on 19/03/2022 - 14:52

      My friend literally just suggested this - where did you go to for reviews etc? Which clinic did you go to? Bali was another option that was floated for similar reasons too

      • harveyworld on 19/03/2022 - 23:43
        +2

        This is the one that my wife went to in Phuket, Thailand….

        https://www.phuketsmiledental.com

        It had a good reputation and we couldn't fault it, but do your own due diligence on anything like this and ask lots of questions beforehand.

        As I say this was a few years ago but I managed to find the website so they must still be going strong.

  • screensaver on 19/03/2022 - 13:40

    Some have a Smile Dental Club. Medibank has a Live Better App which lets you earn up to 30000 points per year. This will get $200 premium and a $50 chemist voucher or a $300 chemist voucher or other reward including extras, I am about to pick up a $140 chemist voucher

    • cloudy on 19/03/2022 - 13:49

      Yea but the chemist is only amcal. And those vouchers are single use only, so anything left is forfeited. Plus amcal is more expensive than chemist warehouse

      • screensaver on 19/03/2022 - 13:54

        I am getting smaller vouchers. And its free money as I pay no more for my premium, Also Amcal has a generous rewards program

  • Oofy Doofy on 19/03/2022 - 14:47

    The only time I got any value out of my PHI is when I had surgery. Even then, most surgeons charge above the AMA fee guidelines, so you'll have a significant gap payment. This is more a supply and demand thing, and surgeons can get away with it since the public healthcare system is so stretched.

    • spurf on 20/03/2022 - 08:36

      I think you might be confusing the Medicare schedule with the AMA fee guide. The latter is anywhere between 2 - 4x larger than the former. Most insurers will rebate around 60% higher than the Medicare schedule. The gap you end up paying is anything above what the insurer will pay.

      • Oofy Doofy on 20/03/2022 - 12:36

        Well, all I know is my insurer told me they only cover up to a certain $ amount for a procedure etc, anything over what the fee/s would normally be, they won't cover. There is some kind of scheduled fee list, related to what the AMA guidelines are.

        For instance, recently I paid about 5k out of pocket for a surgery that was 10k, despite having gold level hospital cover.

        • spurf on 21/03/2022 - 09:53

          Unfortunately, the system is obtuse for a reason as it is the best compromise for all the key players except for the consumer. Insurers have the freedom to set rebates independent of any real world factors such as inflation. They get to hide behind terms such as "Top Cover" which has nothing to do with how much they pay practitioners but defines what procedures they will or won't cover. Doctor's are given the freedom to charge independently of patient's insurance status and are not allowed to compare their fees to other practitioners due to competition laws. Federal government get to blame state government for public hospital underfunding. State governments get to blame federal government for inadequate medicare funding.

          The best solution to the above is a massive investment in the public hospital system to give consumers a low cost alternative to the private sector. Bring waiting lists to see a specialist and be operated on to a reasonable level for all procedures to make the private sector compete on quality not artificial scarcity. Of course this would need a commitment to increase taxes and continually so to match the ever growing need to spend a larger portion of government revenue on health with an ageing population. Australians though seem more and more allergic to paying tax and seem more comfortable paying more by being gouged by the "free market".

          • Oofy Doofy on 21/03/2022 - 15:40

            @spurf: Completely agree.

            Although the AMA is a Medical Mafia. I can give many historical legal examples, and that's just scratching the surface.

            Don't go thinking the AMA is this wonderful, loving, caring and reasonable organisation.

            They're as much to blame as the blame they place on successive governments for reducing funding of public health.

  • DingoBilly on 19/03/2022 - 17:26
    +3

    I've made a profit from my extras insurance every year I have it to counter some of the other posts in here.

    It's pretty easy to run the calculations for whether it's worth it - but for dental, optometry and physio it's almost always worth it. I pay $200 a year which easily covers dental costs for my year (which is about $400), physio ($300), and optometry if I want it. Net +$500.

    Doesn't really help you with your expensive dental - for that as others have recommended I'd look overseas.

    • chrislinke on 20/03/2022 - 08:47

      agreed! Thinking others might be comparing entire PHI cost vs extras claims, which is always going to be a loss. If you need glasses and use your dental, I find it hard to not break even on extras.

    • HiDave on 20/03/2022 - 22:20

      Hi Billy, which insurance do you use, please?

  • Dejaar on 20/03/2022 - 08:43
    +1

    Extras are refreshed on 1 Jan, so you may be able to get part of the procedure done in Dec and claim and then have a second procedure in January and claim in the new year.

    • iCandy on 20/03/2022 - 10:10

      This. I started the process for an implant last October on a tooth that had been root filled and crowned 30 years’ ago. BUPA paid $1,100 towards that in October then another $1,100 a week ago when I had the impressions taken. Having said that, implants are very expensive here and I won’t be getting another one. Fun fact: root canal work is not considered permanent by most dentists. It’s very possible you will need that tooth extracted at some stage. You can also get abscesses again in root filled teeth. Old crowns used huge posts which crack the tooth’s root and allow bacteria in. Source: experience.

    • cimrak on 20/03/2022 - 14:18

      this is not always true - check with the mob you are looking at.

      As an example, I'm with AHM and everything resets based on the financial year, not the calendar year.

  • BigBirdy on 20/03/2022 - 10:26

    With PHI, it’s not just the rebate/gap that matters. If your insurer has a relationship with your provider, you get a cheaper price as well. Eg I just got a dental cerac crown. Standard price was $1700. Price dropped to $1300 because of relationship. Rebate $400. Gap $900, so savings over having no insurance was $800. I also had two very old fillings replaced (they were failing). Total savings was more than two years of insurance premiums.

  • ihbh on 20/03/2022 - 17:17

    How to Break Even on Extras Cover

    If you're going to break-even, just do it directly and cut out the middle man and save time and effort.

  • Essem on 20/03/2022 - 17:52

    Annual limits will restrict the amount you can claim. With Health Partners Gold Extras annual limit for major dental is $1,000 at their Dental Centre plus 40% unlimited if you reach limit. I use nearly all my extras, max benefit in physio, chiro, dental and optical. If you don’t regularly use the services you’ll never make it worth it. I’ll never be without it while I’m working and can afford premiums.

  • jaswanthjassu on 20/03/2022 - 18:41

    I had my root canal done in India for $60..and a crown on that tooth for $160. Thats for a reputed dentist. This was in 2017..Next month I am going back to him for implant.

    I had very good experience with a dentist in Philippines too..she charged me $ 200 for an open flap surgery for 2 quadrants..but that was 10 years ago.

  • utsc on 07/09/2022 - 12:18
    +1

    Any insurer providing a 2 months waiting period wavier for Extras Only policy?

    HCF provides waiver but they need you to maintain both Extra's and Hospitals policy. For RAC members there is a $400 cash back offer for maintaining both hospital and extra's cover. which might offset the cost of Hospitals coverage

    • El-Rhi on 08/09/2022 - 06:52
      +1

      HCF will sometimes waive the 2 month waiting period on extras if you have Flybuys. Give them a call or chat to them online

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