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What does dental insurance cover?
Dental insurance helps cover the cost of dental treatments, such as check-ups, cleanings, fillings and more. It reduces out-of-pocket expenses to make dental care more affordable. In Australia, dental insurance is often included as part of an Extras health insurance policy. This provides coverage for various dental services based on the level of cover you choose.
Extras cover typically comes with limits on how much you can claim each year, and some services may only be partially covered. For example, an Extras policy might cover general dental services like cleanings and check-ups, but you may only receive 60% of the cost back or have an annual claim limit, such as $750.
Extras policies with dental come in different levels, from basic to top, with different benefits, limits and premiums depending on what policy you choose. While most dental insurance falls under Extras cover, you might be able to claim for dental procedures carried out in a hospital under your Hospital cover. This could include accommodation and operating theatre fees for the likes of dental surgery for implants or wisdom teeth removal.
Here’s a general overview of what’s typically covered on Extras:
1
General dental
This usually includes exams to check for cavities and gum disease, as well as preventative treatments like check-ups, cleanings and polishes. General dental may also cover plaque removal, some tooth extractions, fillings and x-rays. While most Extras policies include general dental, coverage may be limited on Basic and Bronze plans. Waiting periods of two months normally apply, meaning you won’t be able to make a claim straight away.
2
Major dental
Major dental covers more complex procedures, such as endodontics (root fillings) and treatment for periodontitis (gum disease). It may also include crowns, bridges, dentures, major restorative fillings and oral appliances for sleep apnoea. Major dental coverage is typically available on top-level Extras policies, like Silver and Gold, and may be particularly beneficial for seniors. 12-month waiting periods usually apply for major dental treatment.
3
Orthodontics
Orthodontics is a type of specialist dental care that corrects the alignment of teeth using appliances such as bands, braces and clear aligners. Similar to major dental, orthodontics is generally only available with higher levels of Extras cover, such as Silver or Gold, and may be worth considering if you are purchasing family cover or single-parent health cover. Keep in mind that orthodontic treatment usually comes with a 12-month waiting period.
Maximise your cover by choosing a dentist that’s part of your health fund’s preferred provider network
Chris Whitelaw, General Manager - Health Insurance at Money.com.au
“Most health insurers have agreements with specific care providers, which means you may not receive the full benefits of your coverage if the dental practice you choose isn’t affiliated with your insurer. Insurers usually have a network of healthcare providers, so it’s a good idea to check which ones they partner with before scheduling an appointment.”
Chris Whitelaw, General Manager - Health Insurance at Money.com.au
Why take out private dental cover?
Having dental cover can be a great way to maintain your oral health without facing high out-of-pocket expenses. Regular check-ups and cleanings help identify problems early, potentially saving you from more expensive treatments later.
A recent Money.com.au survey found 52% of Australians chose Extras cover for dental check-ups and cleans, the most popular reason. This was far higher than for optical care (26%) or physiotherapy and chiropractic treatments (14%). By generation, 59% of baby boomers chose Extras for dental, followed by 53% of Gen X, 50% of Millennials, and 45% of Gen Z.
The growing focus on dental care is reflected in the numbers, with private health insurance subsidising over 50 million dental services in 2022-23, according to the Australian Prudential Regulation Authority (APRA).
Data from the Australian Institute of Health and Welfare (AIHW) also revealed that 52% of Australians aged 15 and over visited a dental professional in 2022-23. However, the cost of dental services can vary significantly, even for common procedures, which is why having private dental cover can help manage gap expenses. For example:
- Preventative services, like plaque and stain removal, cost between $23 and $129, with benefits ranging from $14 to $80, leaving a gap of $0 to $88.
- Restorative services, such as adhesive restoration on an anterior tooth, range from $50 to $290, with benefits from $25 to $156 and a gap between $0 and $221.
- Tooth extraction costs range from $67 to $420, with benefits from $28 to $207, and gaps between $0 and $337.
- A full crown can cost between $800 and $2,750, with benefits ranging from $63 to $1,375, and gaps from $62 to $2,200.
Chris Whitelaw, General Manager - Health Insurance at Money.com.au
“Preventive dental check-ups can help you stay ahead of serious health issues. Many health insurers offer at least one free scale and clean with their preferred providers each year, and some even cover multiple visits. Taking advantage of this service is a great way to protect your teeth while getting more value from your Extras health insurance. In fact, a recent Money.com.au survey found that 24% of people ranked routine dental care as the top health or wellbeing service they’d invest more in.”
Chris Whitelaw, General Manager - Health Insurance at Money.com.au
How much does dental insurance cost?
The cost of dental insurance in Australia depends on factors such as your level of coverage, health fund and the services included in your Extras policy. On average, you can expect to pay anywhere from $20 to $280 per month for Extras, which includes dental cover.
A basic policy usually covers just one dental check-up per year, while a top-level policy offers a wider range of benefits, including major dental work and orthodontics, along with higher annual limits and sublimits.
However, having dental cover doesn’t always mean you won’t face out-of-pocket expenses.
According to the latest numbers from Australia’s private health data agency, AIHW, the costs charged to policyholders, the rebates provided and gap payments vary across each state. The chart below breaks down the median charge, benefit paid and out-of-pocket cost for a comprehensive oral examination in 2021-22.
Private dental insurance vs Medicare
Dental insurance
- Typically available on most Extras health insurance policies, with a range of coverage options to choose from
- Basic policies may have limited coverage, so opting for a higher-tier plan can provide higher annual limits and more comprehensive treatment options, though it comes at a greater cost
Medicare
- Most dental services, including general, major and orthodontic treatments, are not covered or subsidised
- Eligible children can access up to $1,132 every two years for basic dental services (check-ups, fillings, extractions) under the Child Dental Benefits Schedule (CDBS)
- Eligible low-income individuals and concession card holders may receive coverage through state and territory government dental programs
How to choose the best dental insurance
Here are some key points to consider when choosing the best dental insurance in Australia:
Scope of coverage
Look at the range of dental services included in the policy, such as general/preventative care (check-ups, cleanings, fillings), major dental (bridges, crowns, root canals), and orthodontics (braces, aligners). Ensure the cover matches your dental care needs and budget, whether you want basic coverage or more extensive treatment options.
Annual limits on benefits
Check the annual limits on claims for dental services. Some policies may have higher limits and sublimits for major procedures, while others may focus more on preventative care. Compare how much you can claim each year and whether these limits meet yours or your family’s needs.
Preferred provider networks
Most health funds have a network of preferred dentists and oral specialists, which can offer higher rebates or reduced out-of-pocket costs. If you already have a preferred dentist, confirm if they are part of the health fund’s network before switching.
Waiting periods
Most Extras policies have waiting periods. For general and preventative dental, you’ll typically wait two months, while major and orthodontic treatments usually have a 12-month waiting period. If you’re switching to the same or lower level of cover and have already served the waiting periods with your previous provider, they may be waived. Some funds also offer health insurance with no waiting periods to attract new customers.
Many health funds offer sign-up deals and perks to encourage new eligible customers to switch. These offers can include credits, cashback, waiving of waiting periods, and even gift cards. Additionally, some providers offer multi-policy discounts if you bundle your health cover with travel insurance, car insurance or home insurance.
