Dental Health Insurance in Australia

Published: August 26, 2019

Unless you’re eligible for public dental care, you are responsible for paying all dentistry costs. One way to save on dental expenses is to consider dental insurance.

Dentistry in Australia is very expensive and not generally subsidised by state or federal government. However, you can find a dental insurance plan with private health insurance. Extras cover that includes general and major dental benefits, might help you cover some of your dental expenses. Your benefit limit and the services you can claim will depend on the level of cover you choose.

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Health insurance with dental cover in Australia

With an Extras health insurance policy, you can claim dental benefits. However, your level of cover will determine the type of benefits you have access to and whether you are partially or fully covered. Types of dental coverage include: General dental, Major dental, Orthodontics and Endodontics.

What dental procedures does health insurance cover?

With an Extras health insurance policy, you can claim dental benefits. However, your level of cover will determine the type of benefits you have access to and whether you are partially or fully covered. Types of dental coverage include: General dental, Major dental, Orthodontics and Endodontics.

The benefit of having an Extras policy is that it can provide you with benefits for general dental treatments (cleaning and fillings) and major dental procedures (crowns and dentures). Depending on the level of coverage you choose, you might also benefit from orthodontics (braces) and endodontic work (tooth decay and damage).

Take note: Generally, only Top Extras policies provide cover for orthodontics and endodontics.

What does General dental cover?

General dental typically helps cover the cost of preventative dental treatments. You can get general dental by purchasing an Extras policy. While each health fund is different, general dental usually includes dental check-ups, teeth cleanings, small fillings, dental x-rays, and plaque removal.

However, when choosing general dental cover, it's essential to understand the two subcategories:

  • Limited: A maximum financial limit applies to the total rebate your private insurance provider will pay, for a specific dental item each year.
  • Unlimited: If an item is unlimited, you can claim on those items as many times as you like.

What is Major dental insurance?

Major dental care generally covers the more specialised dental issues, typically those requiring surgery — for example, wisdom teeth removal, crowns, bridges, dentures, and root canal therapy.

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Waiting periods for private health insurance dental

While each health funds set its own waiting periods, generally you can expect to wait:

  • 2 months for General dental services.
  • 12 months for Major dental procedures.
  • 12 months for orthodontics.
  • 6 to 12 months for Endodontic.

Can you get dental health insurance with no waiting period?

While some health funds may have shorter waiting periods, they won't generally waive the waiting period for dental care. Waiting periods for most health insurance services, including dental, is to protect the health funds from people taking out insurance, claiming and then immediately dumping their coverage.

Best health insurance for dental

The best dental insurance plan for you depends on the state you live in, how many people need covering, the level of cover you want and your general oral health. To find a plan suited to your requirements, you might want to compare some of Australia’s biggest health funds and the benefit limitation they provide for dentistry.

Examples of dental insurance (General and Major)

Health fund and policy name Additional benefits
Australian Unity
Advanced 80% Extras
Australian Unity No Gap Dental: Eligible members can get preventative dental treatment (for example, scale and clean, x-rays and initial examinations) at no-out-of-pocket costs (up to your yearly limit) when visiting an authorised provider.
Bupa Top Extras 90 Bupa Dental: Eligible Bupa members that combine their Extras policy with Hospital cover, might not have to pay anything for regular check-ups and other preventative services. You can generally also get gap-free kids' dental on selected covers from Bupa's list of providers.
HIF Super Options HIF SmartTeeth: With this benefit program from HIF, they will pay a percentage of your dentist's fee, up to a maximum benefit for each item of service. You are not restricted to ‘contracted' suppliers.
Nib Top Extras Nib Dental Care Centres: Up to 100% back on check-ups when visiting a nib Dental Care centre. Examples of services include examinations, bitewing x-rays, scale and clean.
HCF Top Extras With HCF Dental Centre and More for Teeth providers, you can get up to 100% back on a range of preventative dental services, such as mouthguard, check-ups and scale and clean.
Source: From each respective health fund's website (August 2019).

Take note: With many health funds, you’ll need to attend one of their preferred providers to gain access to the benefits mentioned above.

How to choose a dental plan?

Factors that will help you determine which Extras policy with dental cover is best for you, include:

  • Your age: A higher level of dental coverage is usually required as you get older.
  • Your oral health: The current condition of your teeth and gums will also help you determine the level of dental cover yo' need.
  • Your budget: Don't invest in a policy that you can't afford, especially considering you'll have to serve a waiting period before you can claim benefits.
  • Your family: If you have children, then you might want to consider a policy that will benefit them now and as they get older.
  • Annual limits: Some treatments are subject to an annual limit, which is the total amount you can claim each year.
  • No gap dental: Select health funds offer no-gap benefits, which means you have little to no out-of-pocket costs for general dental services.
  • Waiting periods: Compare the amount of time a health fund requires you to wait before you can claim a specific benefit.

Does Medicare cover dental?

In Australia, dental health services are generally not covered by Medicare. Australians usually pay for their own dental care out-of-pocket or with the assistance of private health insurance. However, all states and territories in Australia provide public dental services to its eligible residents, generally, through government clinics.

Eligibility is typically based on your socio-economic status. Concession cardholders and other financially or geographically disadvantaged people usually have access to public dental clinics and will receive a limited range of dental treatment.

Take note; dental services, waiting times for treatment, fees and subsidies that apply will vary between states and territories.

The Child Dental Benefit Schedule (CDBS)

The Commonwealth provides dental benefits (capped at $1,000 over two calendar years) for children between the ages of 2 and 17, whose families receive a Family Tax Benefit Part A or a relevant Australian Government Payment. The benefits that are covered include:

  • Examinations
  • X-rays
  • Cleaning
  • Fissure sealing
  • Fillings
  • Root canals
  • Extraction

However, orthodontics and cosmetic dental work are excluded, and no benefits will be paid for services provided in a hospital.

Frequently asked questions and answers

How much is dental health insurance?

On average, an Extras policy that includes both General and Major dental insurance can cost between $48 and $174 a month. However, cheaper plans generally have lower benefit limits. More expensive policies will usually provide coverage for orthodontics and endodontic treatments.

Which dental health insurance is best for seniors?

If you’re over the age of 65, you might want to consider an Extras health insurance policy that includes Major dental care and Endodontics. As you get older, your oral health tends to decline, and you're more susceptible to tooth loss, gum disease, and needing root canal therapy.

Can you get major health insurance with no waiting period?

No, as with pre-existing medical conditions, major health insurance policies generally require you serve a 12-month waiting period.

Does insurance cover cosmetic dentistry?

Cosmetic dental work that improves your appearance and is not medically necessary (not for functionality) is generally not covered by private health insurance or Medicare. Aesthetic dentistry examples include teeth bleaching, porcelain fillings, and enhancing the shape and size of teeth.

Does health insurance cover dental implants?

If your dental plan covers major dental, then a portion of your dental implants are likely to be covered. In Australia, dental implant treatment can cost upwards of $5,000. Before you book your surgery, be sure to contact your health fund to find out the out-of-pocket expenses you should expect.

What dental insurance covers braces?

Health insurance that includes benefits for orthodontics will generally help you pay for braces. The amount you can claim and the annual limit will depend on your health fund and level of Extras you purchased.

Does health insurance cover wisdom teeth?

If wisdom teeth removal needs to be performed in a hospital, you likely need a combination of Hospital and Extras health insurance. Ask your dentist/oral surgeon how complicated your procedure will be.

Does health insurance cover dental prescriptions?

In Australia, a benefit payable toward medications is generally made from the Pharmaceutical Benefits Scheme (PBS). However, if your prescription is not subsidies by the Government under the PBS and you have an appropriate Extras policy, private health insurance might be able to pay a benefit toward these medicines.

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