It’s reassuring to have health insurance, especially when it comes to dental cover. But while many Aussies choose private health insurance to cover their dental expenses, it does come at a cost.
We break down the vital details below to help you decide the best cover for your needs.
What we discuss:
- What is dental cover?
- Understanding the categories of dental services
- What your dental health insurance actually covers
- Understanding dental cover limits
- How to get the best value from your dental extras
- Popular insurance companies for dental cover
- FAQs
What is dental cover?
Dental insurance is typically a form of an ‘extras’ cover that can be added to your private health insurance policy. This extras cover is how most Australians pay for their dental care. Insurance companies typically only pay for part of the cost, though, with the individual paying the balance from their own pocket.
Categories of dental services
Your ‘extras’ dental cover is generally split into two categories: general dental and major dental. There is an annual payout limit for each category. (These categories are often split further, as we highlight below.) Payout limits vary, depending on your insurance provider and the level of cover purchased.
Below is a breakdown of how dental services are typically categorised.
Preventative dental
Think of this as anything to keep your teeth healthy and avoid larger bills later.
- Examinations – An examination of your teeth, gums and mouth, performed by a hygienist or dentist.
- Scale and clean – Removing tartar and plaque that cannot be removed by brushing and flossing at home.
- Custom mouthguards – Custom fitting mouthguards for sporting activities to prevent damage.
Restorative dental
This category is for minor treatments that fix common dental problems. NB: Some insurance companies place restorative dental items in their preventive or major dental categories.
- Tooth fillings – Simple fillings to restore the tooth and prevent further decay.
- Tooth extraction – Removing teeth, including wisdom teeth
Major dental and implants
This is for complex treatments that involve repairing or replacing teeth. NB: Some insurance companies categorise dental implants and orthodontics as “complex dental”.
- Dental bridges – to replace one or more missing teeth with a prosthetic tooth/teeth.
- Crowns – a cap-like cover that is placed over the damaged tooth.
- Endodontics – to treat the tooth’s pulp and tissue surrounding the tooth’s roots. Typically, this involves treatments like root canal.
- Tooth veneers
- Dentures
- Wisdom teeth removal
Orthodontics
Orthodontics treatments help straighten teeth and fix problems such as chewing, biting and tooth alignment.
- Palatal expanders – appliances that widen the upper or lower jaw to help prevent tooth crowding
- Braces – various brackets and bands that help align and straighten teeth.
What (& how much) your dental health insurance covers
Check your policy to see your annual limits — and how much you can claim. If you’re about to purchase health insurance, be aware that various health insurance funds categorise things differently. We recommend you familiarise yourself with the following two terms:
Limits – When you claim on an extras policy, there are limits on the amount you can claim. These differ depending on the health insurance you choose, so check closely. See below for more information o’s n limits.
Level of cover – Typically, your extras health insurance policy is divided into levels based on the amount you pay and the services they cover. Your circumstances, budget and healthcare needs will help determine the level of cover that’s right for you.
KEEP YOUR LIFE STAGE IN MIND
As we travel through life, our needs change. For example, younger people may need orthodontics and wisdom teeth removal, while seniors gravitate towards tooth extraction, root canal, dental implants and dentures.
Check your policy to see if it adequately caters for your life stage.
Dental cover limits: a closer look
Insurance companies classify limits in various ways. For example, there are:
- Annual limits (e.g. $1,000 per year on dental)
- Sub-limits – e.g. a maximum of $400 out of the $800 on major dental
- Dollar limits per item number
- Lifetime limits – e.g. no more than $3000 spent on orthodontics for an individual’s lifetime
- Service limits – e.g. a clean and scale may only be claimable every six months
- Group limit with other ancillary services – e.g., a group limit to spend across all dental services – major, general and endodontic services)
Getting the best value from dental extras
With so many insurance companies and varied levels of extras cover, it pays to do your homework to ensure you’re getting the best value. Here’s how.
Compare policies – shop around and use government-funded comparison sites such as privatehealth.gov.au or private sites such as Compare the Market or iSelect.
Be clear about what you’re covered for – If you have a health concern or requirement (e.g. implants or braces), check directly with your potential provider to see if you’ll be adequately covered.
Look for combined limits – Some insurance companies will combine all or some categories of dental treatments under a single limit. If you needed a particular service for one year, you could use all your allotted funds for that one service.
Assess out-of-pocket expenses carefully – Be aware of any exclusions and benefits. For example, they may advertise that you can spend up to $500 a year, but there Could be a limit of only $50 per visit. The rest would have to be paid from your own pocket.
Discover preferred providers – These are dental clinics that have an agreement with the health insurance fund to offer select services at a cheaper rate — or for no out-of-pocket expense. They are only available at specific locations, so they will only be helpful to you if they are nearby.
Common dental cover FAQs
What is the best dental cover?
Finding the best dental cover is about finding what works best for you. Factors include the cost, your stage of life, the type of services you need (and if the insurer provides these services), and any limits the insurer places. To find the best dental cover for you, we suggest using government-funded comparison sites such as privatehealth.gov.au or private sites such as Compare the Market or iSelect.
How much does dental insurance cost in Australia?
Basic dental insurance policies in Australia start at around $20-$30 monthly for individuals and $60 – $80 for a family. These policies typically cover the cost of preventative dental care, such as an exam, clean and scale.
Does Medicare cover dental?
Medicare does not cover most dental services, and most people don’t receive government-funded dental services. However, some individuals receive government assistance, such as children under the CDBS (Child Dental Benefits Schedule) and adults with a health care card or Centrelink pensioner concession card. You can read more about why Medicare doesn’t cover dental here.
Who gets free dental in Western Australia?
The majority of West Australians do not get free dental. However, various groups are subsidised. For example, dental clinics operating throughout WA’s metropolitan and country areas offer government-subsidised general and emergency dental care, provided they are aged 17 and over and hold a current health care or pension concession card. Children aged up to 4 years old (whose names appear on their parents’ health care or concession card) are also eligible for subsidised dental care.
Schoolchildren aged between 5 and 16 years who attend a WA Department of Education recognised school receive free general dental care via the School Dental Service (SDS).
Children with a parent or guardian receiving government assistance may receive the Child Dental Benefits Schedule (CDBS). Find out more about the CDBS here.
What percentage of Australians have dental health insurance?
According to The Australian Institute of Health and Welfare, 51.1% of Australian males and 54.3% of females aged 5 years and over have private health insurance for dental expenses from 2017 to 18.
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