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Dental care is the care of the teeth and mouth provided by a dentist, dental specialist or another health professional. While you aren’t legally required to have insurance cover for dental, without it treatment could cost hundreds or even thousands of dollars.
In Australia, dental services costs can vary widely from dentist to dentist because unlike in the case of doctors, there are no standard fees set for dentists. They generally charge different amounts based on where they practice and what methods they use.
That has meant a growing inequality in dental health, with millions of Australians going without treatment as private dental care, even via private health insurance, becomes increasingly expensive.
In fact, according to government data, nearly a third of Australian adults over 15 years of age have untreated tooth decay. Here’s how you find the best health insurance for dental which should help you flee from the fillings.
How Is Dental Covered Under Health Insurance?
Most dental care in Australia is provided in private dental clinics. Private health insurance can help to pay for the costs of dental care that is not routinely covered by Medicare.
Dental is covered under private health in a range of ways: in some policies, it is partly covered under hospital cover, in others, there is reimbursement for ambulance cover.
Related: Our Pick Of The Best Private Health Insurance Providers In Australia
But mostly, dental insurance is generally a form of an extras cover that can be added onto your private health insurance policy.
Many Australians use extras cover to pay for dental care. However, most health funds only pay part of the cost, with the balance borne by the individual themselves.
According to government data, Australians spent around $11.1 billion on dental services in 2020–21. Out of this, only around $2.2 billion was funded by private health insurance providers, while around $6.5 billion, or 59%, was paid by patients directly.
What Do Dental Extras Cover?
As part of your insurance plan ‘extras’, dental cover is split into two categories: general dental and major dental. Each category has its own annual payout limit that varies according to the insurance provider and the type of policy purchased.
General dental includes check-ups, fillings, scaling, cleaning, plaque removal and X-rays.
Major dental includes root canal, crowns and bridges, surgical removal of teeth such as wisdom teeth, dentures and implants.
Health funds generally pay a portion of the service fee, with benefits varying between funds. Dental fees themselves also vary widely because there are no set amounts for specific treatments.
According to the Australian Dental Association, the average cost of a regular check-up is around $214.
Is Dental Covered By Medicare?
Medicare doesn’t cover dental services in most circumstances. The system doesn’t generally pay towards out-of-hospital services like physiotherapy, podiatry and dental for most Australians. This includes most dental examinations and treatment.
The only exceptions are some essential dental services for children under the Child Dental Benefits Schedule, and for eligible adults in some states and territories that provide public dental services such as in emergencies or referrals to specialist services like orthodontics in hospitals.
When the Whitlam Government set up the precursor to Medicare in 1974, it is believed dental care was not included because of stiff additional costs that would have been involved, as well as for political reasons, with the provision of public dental health services long been seen as the responsibility of states and territories.
However, consumer groups and some political parties have increasingly argued for the inclusion of dental services under the Medicare system.
Consumers Health Forum of Australia says the current system does not align with consumer expectations of health care in Australia. The consumer lobby group has been calling for a national, universal approach to oral and dental health to address the problem that preventable dental issues could have in the future on the wider health system.
“What we don’t want to see is consumers not being able to receive the oral care they need when they need it and so instead waiting for their problem to get so big their only option is to go to hospital,” CHF chief Dr Elizabeth Deveny said.
How Much Does It Cost?
The price of dental treatments generally depends on the dentist, their location as well as the specific circumstances for the patient. Common treatments can average from $170 for a dental check-up to $225 for fillings to around $400 for tooth extraction and $1300 for root canal.
More complicated dental work, such as braces, can cost between $6,000 and $9,000.
Basic dental extras from health funds start around $4 a week or roughly $200 a year, which covers routine check-ups and teeth cleaning. More advanced dental treatments, such as endodontics and orthodontics, can cost between $7 to $9 a week.
However, in most cases you may still have out of pocket expenses because the insurance fund only covers part of the cost. Dental cover is also generally subject to:
- Annual limits (for eg. $500 a year on dental)
- Sub-limits (such as a maximum of $250 out of $500 on major dental)
- Dollar limits per item number
- Per person limits (eg. $500 annual limit per person).
Related: Do I Need Private Health Insurance?
How to Save on Dental Extras?
Given how expensive dental treatments are, it pays to choose your extras cover wisely. Here are a few tips to help you save on dental extras:
1. Find out exactly what you are covered for: Consumers Health Forum chief Dr Elizabeth Deveny says if you have particular health needs or issues, you should first speak with your potential provider to see if your needs will be covered sufficiently.
“People need to make sure that they understand their health insurance policy and what is and isn’t covered at the time they sign up. You don’t want to see people paying essentially for junk policies.”
2. Compare policies: Experts encourage people considering their private health insurance options to shop around and use the government’s comparison site—privatehealth.gov.au or even other comparison websites, where consumers can compare policies and find policies that match their needs.
3. Look for combined limits: Some insurers combine all or some categories of dental treatments under a single limit. For example, routine dental, major dental, endodontic and orthodontic may all have a single limit of $1200 a year. This can be useful, because you might not need root canal treatment every year, so the entire limit can be used towards general and major subcategories, while still giving you the option of using it on endodontic treatment when needed.
4. Weigh the out-of-pocket expenses: CHF recommends that when considering a policy people should look for any exclusions as well as the annual and lifetime caps on benefits.
Health funds generally advertise the headline limits on what you can spend on a particular service, such as $500 on dental a year. But they don’t usually advertise their individual item limits. For instance, you may be able to claim $50 per visit to the dentist, which means you’d have to go 10 times a year to claim the full amount, while also leaving you to cover the gap.
5. Find out about preferred providers: Look on the insurers website to find out about preferred providers in their region as this can give higher or additional benefits. Also check if your provider has agreements with dentists in your area who provide service for a capped or no fee.
Which Is The Best Fund For Dental Extras?
As with other types of general insurance, the private health insurance market is quite competitive in Australia. Some of the larger health funds offering dental extras include:
Most of the alternatives provide various levels of cover at different prices and a number of add-ons and each of them comes with a number of pros and cons.
What policy is suitable depends largely on individual requirements, waiting periods and your budget.
Frequently Asked Questions (FAQs)
Is health insurance worth it for dental in Australia?
Most dental care in Australia is provided in private dental clinics. Private health insurance can help to pay for the costs of dental care that is not routinely covered by Medicare.
Is private health for dental worth it?
Some consumer groups estimate there is no net benefit of taking out extras cover with your health fund. However, dental is often one of the key reasons many people take out general cover, because treatment can cost hundreds or even thousands of dollars.
Is dental covered by Medicare Australia?
Medicare doesn’t cover out-of-hospital services like dental in most circumstances. The only exceptions are some essential dental services for children under the Child Dental Benefits Schedule, and for eligible adults in some states and territories that provide public dental services.
