For people with HIV, access to good affordable dental care is vital to our health and wellbeing. Ninety percent of us will get at least one oral health condition linked to HIV.
These conditions can affect our comfort, appearance, self-esteem, diet and speech. They can also make other conditions more serious. It can be easy to forget – until something goes wrong – how important our teeth and mouth are in daily life. Keeping on top of oral health is not only an important part of staying healthy, it is also fundamental to how we project ourselves, communicate, are viewed by others and view ourselves.
Knowing where to get dental care can be confusing. If you are in pain and need urgent treatment, the last thing you want is to be chasing around trying to locate a dentist who knows about HIV and will see you. By understanding the types of programs that are available for people with HIV – and which one is best suited to your circumstances – you will be in a better position to access emergency treatment as well as finding a dentist you know and trust, for ongoing care.
Dental care for people with HIV in NSW
Currently there are four different ways you can get dental care – depending upon your circumstances (where you live, if you have a Concession Card or not, and if you can afford to pay for private dentistry)
- The 2.3 Program provides a public dentistry funding enhancement designed to give people with HIV better access to appropriate dental services. The Program operates at two sites in the Sydney metro area and in the North Coast Area Health Service. You will need to be a concession card holder to be eligible.
- Access to public dentistry services is available for all concession cardholders in NSW, usually via non-specialist Community Oral Health Clinics.
- You may also be eligible for Medicare rebated dental treatment from private dentists through a Commonwealth funding program. This generous scheme may present the best opportunity for people with HIV to access appropriate dental care, particularly those with serious or pressing dental issues. The scheme is likely to be replaced by a new Commonwealth Dental Health Program which will be announced in the May 2008 Federal Budget. The access details and eligibility criteria are covered later in the article.
- Private Dentists
1) The 2.3 Program is for people on a concession card - who live in Sydney or the Northern Rivers
If you have HIV and a current Health Care Card or Pensioner Concession Card, you can access free dental treatment and specialist dental care through the 2.3 program. The 2.3 program is available at Sydney Dental Hospital, St Vincent’s Hospital Dental Department and in the Northern Rivers area.
Sydney Dental Hospital provides a complete range of treatment and care including specialist treatment, although waiting times for an appointment can be lengthy. St. Vincent’s Hospital Dental Department provides a more basic range of treatment and doesn’t include specialist or reconstructive dentistry. Getting an appointment is usually easier. When calling to make an appointment at either location, be sure to tell reception staff that you want to be treated under the 2.3 Program.
The types of treatment offered and contact details for each service are as follows:
Sydney Dental Hospital - 2 Chalmers Street, Surry Hills (near Central Railway Station). The Community Oral Health Clinic provides general oral health care under the ‘Program 2.3’. This is where all new patients are assessed. You will be prioritized according to the severity of your condition. Waiting times range from 24 hours for life threatening, acute and trauma conditions, to four weeks for less serious conditions. There are usually waiting lists for both assessment and specialist treatment. Sydney Dental Hospital receives referrals for specialist care from across NSW.
For an appointment phone the Sydney Dental Hospital Business Support Manager on (02) 9293 3245 between 8.30am and 4.00pm Monday to Friday.
To protect your confidentiality your records will not state that you are a ‘Program 2.3’ patient, but simply a ‘Special Program’ patient, which includes other special assessment programs.
St. Vincent’s Hospital Dental Department - Victoria Street, Darlinghurst.
The Dental Department works closely with the hospital’s HIV Medicine Unit, community and hospital-based HIV GPs, and Specialists to provide general dental treatment and management of most oral problems arising from HIV infection. It provides assessment, cleaning, fillings and extractions but not specialist or reconstructive dentistry (e.g. root-canal and crowns). If you need specialist care you will be referred to the Sydney Dental Hospital.
For appointments call: (02) 8382 3129. If you are in pain or experiencing swelling, you should generally expect to be seen the same day.
North Coast Area Health Service (from Grafton to Tweed Heads)
For information about non-urgent care, contact the ‘Program 2.3’ Dental Manager on (02) 6620 2617. To be eligible for this program you need to be HIV positive, be on a low income, and have been resident in the area for at least six months.
Application forms are available from Clinic 145, SHAIDS: (02) 66 2029 80 and from the ACON office Lismore: (02) 6622 1555
If you are experiencing acute (urgent) dental pain, but have not yet talked to your GP about registering for the ‘Dental Program 2.3’, the North Coast Area Health Service provides emergency dental treatment. Contact your local Community Health Dental Clinic, which is listed in the telephone book. Outside working hours, contact the Accident and Emergency Department of your local hospital.
2) Access to public dentistry other than Sydney and Northern Rivers areas
If you’re a concession card holder and/or a pensioner, dental treatment is available from Community Oral Health Clinics in your local area and will cover most dental care including preventative work, restorations, extractions and minor surgery. Talk with the HIV and Related Programs (HARP) team in your Area Health Service. The number for the Area Health Service will be listed in the telephone directory for your area.
3) Medicare rebated dental treatment from private dentists - for people with chronic and complex conditions (including HIV).
Enhanced Primary Care (EPC) Dental Program.
You may have heard about a new Medicare dental program that will pay or help pay for dental treatment. The treatment is provided by private dentists. A number of people with HIV have been referred by their GP and are currently receiving treatment.
The Rudd government plans to scrap this scheme and replace it with a Commonwealth Dental Health Program. The details are not yet available although the new program will be announced in the 2008 Budget in May. It is unlikely that the current dental arrangements will be withdrawn before May 2008. While there are no details on the transitional arrangements, it is likely that people who are already on a EPC dental treatment plan - when the EPC dental arrangements are withdrawn - will be ‘grandfathered’ and retain some access to the program.
For some people with HIV, particularly those with serious or urgent dental issues, it is important to discuss with your GP (as soon as possible) arrangements for accessing the EPC dental program, before they are withdrawn.
EPC Dental Program – Detail:
From 1 November 2007, people with chronic and complex conditions have been eligible for up to $4,250 of Medicare rebated dental services over a period of two calendar years. The new scheme replaces the three rebated dental services per year that were available through the Enhanced Primary Care (EPC) scheme. That scheme finished on 31 December 2007 and has been replaced by the new rebated items.
The scheme involves paperwork, forward planning, and is limited by the level of Medicare rebate. Unless the dentist bulk bills (and some don’t), you will have to pay the gap between the up-front cost of treatment and the amount reimbursed by Medicare. If you think you qualify and could benefit from this generous scheme, talk with your GP.
You are eligible if you have a chronic medical condition (HIV) and complex care needs (i.e. receiving care from your GP and two other health care providers). Also, your oral health must be affecting or likely to affect your general health.
For most people, access to the program involves your GP preparing a ‘GP Management Plan’ and ‘Team Care Arrangements’ during a consultation. Talk with your GP about your eligibility for these plans. Your GP must complete the plans and bill you before you have your first dental treatment. You can call Medicare on 132 011 to check if the necessary paperwork has been recorded.
Most dental services will be covered including:
- Dental assessments
- Preventative services
- Extractions
- Fillings
- Restorative dental services such as crowns, bridges and implants
- Dentures
- Orthodontic services
However, Medicare rebates will not be paid for dental services that are purely cosmetic and Medicare rebates cannot be claimed for dental treatment provided by public dental clinics.
Most private dentists, dental specialists, and dental prosthetists (people who make and fit dentures and bridges) are eligible to provide services, but some may choose not to treat under Medicare. Your GP will have information about which dentists are registered with Medicare and are willing to take referrals and bulk-bill. You could also check with dentists in your local area and ask if they are registered with Medicare and bulk-bill.
So, how does the program work?
If you have a ‘GP Management Plan’ and ‘Team Care Arrangements’ plan in place, your GP can refer you to a private dentist (who is registered with Medicare) for assessment and treatment.
The referral will last for two consecutive calendar years from your first dental treatment (e.g. if the first dental service is provided on 15 November 2007, your referral will be valid to 31 December 2008). If you need further treatment after this date you need a new referral from your GP. The dentist can also refer you to other dentists and specialists for treatment.
Will I have to pay for the dental services?
Dentists can either bulk bill or set their own fees for services.
The dentist will provide you with a written quote before you start treatment. They may agree to bulk-bill, but they may not. I have received information that at least one dentist in the inner Sydney metro area is bulk-billing most types of treatment and others may follow.
If you are not bulk-billed, you will be required to pay up-front and then claim a rebate from Medicare. You can also get an invoice from the dentist for the unpaid account and get a cheque from Medicare to pay the dentist. You will then need to pay the additional amount not covered by Medicare.
The gap not covered by the Medicare rebate will vary depending on the type of treatment, the fee charged by your dentist and the amount of Medicare rebate for that specific treatment. Remember, if the dentist doesn’t bulk bill, you will have to pay the full cost up-front, then claim the rebate from Medicare
What is the Extended Medicare Safety Net?
The Extended Medicare Safety Net (EMSN) aims to minimise your out-of-pocket costs. The EMSN covers Medicare services provided outside a hospital (e.g. GP, specialists, allied health, dental, X-ray and pathology services).
Costs for these services count towards your annual Medicare Safety Net threshold. The 2008 threshold is:
- $519.50 for concession card holders and eligible families
- $1,039 for all other individuals and families
- These amounts are renewed on 1 January each year and are valid till 31st December in that year.
Once you reach your threshold, the Government meets 80% of the out-of pocket costs for services provided in the remainder of that calendar year until 31st December.
Once you’ve received a maximum of $4,250 for dental services in two calendar years, no further benefits are payable during that period, including EMSN benefits.
How will you know when you are close to the EMSN limit? Call Medicare Australia Patient Enquiry Line on 132 011 to check the amount of Medicare benefits you have received over the two year period.
If you have private health insurance which covers dental services, you will need to choose either your private health insurance or Medicare. You cannot use your private health cover to ‘top up’ Medicare benefits.
If you need more information, talk with your HIV doctor, go to the Department of Health and Ageing’s website at www.health.gov.au/epc or call the Medicare Australia Patient Enquiry Line on 132 011
4) Private Dental Treatment
If you can afford to pay dental costs and/or are not eligible for the publicly funded systems, private dentists are able to provide most dental needs for people with HIV. If they have specific concerns they can consult or refer you to a specialist HIV dental service in Sydney or Northern Rivers.
If you don’t already have a dentist you trust and feel comfortable with, you could talk with your doctor, other people with HIV, or the HIV Health Maintenance Team at ACON (02 9206 2000, acon@acon.org.au).
Before you choose a dentist, you can ask to visit the surgery, get a feel for the atmosphere and talk with them about their experience of treating people with HIV.
Finally, while there is no legal requirement to disclose your HIV status to a dentist, it’s really helpful for a dentist to know if you have HIV so that he or she can be aware of any HIV-related problems that may potentially arise and ensure they are treated before they become problematic.
Until then keep smiling.
Lance Feeney is a Senior Project Officer Systemic Advocacy at Positive Life NSW
