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No one likes having a sore tooth – from getting headaches to difficulty eating due to the sensitivity – the pain is hard to smile through. Waiting weeks or months on end to be covered for major dental is not ideal when you have high levels of dental or oral pain.

If you encounter some pearly white surprises that are giving you a lot of pain and require more than just a check-up or a clean, you need to understand how waiting periods work and make sure your health insurance is ready to cover you for major dental surgery.

Having the right health insurance that covers major dental procedures can make all the difference, and you may be able to avoid waiting periods if you are covered in advance.
Child laughing with mouth open

Why do you need health insurance cover for major dental procedures?

According to dental statistics, there is an abundance of Australians requiring dental services, making the chances of needing major dental services somewhat higher. Major dental services are almost becoming a necessity, with around one in four Australians needing a tooth extraction during their last trip to the dentist, and around 30% having untreated tooth decay.

However, major dental procedures can cost quite a lot. Having a health insurance policy which covers major dental can help prevent your tooth ache from turning into a headache, by assisting with some of the payments – so you don’t need to worry about finding all the money up-front to fix your teeth.

Which major dental procedures and services are covered by health insurance?

Major dental insurance is not a separate insurance and cover for major dental procedures is found as part of extras health insurance policies. While any extras policy will have annual limits on how much you can claim, as well as specific waiting periods, it is still beneficial to have a health insurance policy in place to help cover the costs of major dental services.

Different health funds and policies categorise major dental services differently, however the types of major dental procedures that are usually found in your extras cover include:

  • Complex fillings
  • Dental crowns and bridges – dental implants for a damaged single tooth or multiple teeth
  • Dental veneers – very thin implants that cover the front of the tooth, generally cosmetic
  • Dentures – removable prosthetic teeth
  • Orthodontics – correcting teeth/jaws that aren’t in the right position, generally with braces
  • Periodontics – treatment of gum tissue diseases like gingivitis, infection, and inflammation
  • Root canals – endodontic procedure to dig into cracked tooth and extract inflamed tissue
  • Tooth extraction – tooth removal due to decay or damage (can be basic dental or major dental depending on number of teeth being removed and specification in the health fund’s policy)
  • Wisdom teeth removal – removing wisdom teeth if they damage surrounding teeth or gums

N.B. Cosmetic dental that improves appearance and isn’t medically necessary is generally not covered by health insurance.

Health funds don’t offer cover for major dental procedures without waiting periods. As such, you’ll want to consider taking our cover in advance, so that you’re sat through those waiting periods by the time you start to experience any issues.

How long are waiting periods for health insurance with major dental extras cover?

Cover for a major dental procedures can usually be found in a health insurance policy with extras that includes higher levels of coverage. The government provides guidelines on minimum waiting periods for specific major dental procedures, but the specific waiting periods are individually set by each insurance provider or health fund. It is rare to find a health insurance policy that offers no waiting periods for such expensive treatment.

The Private Health Insurance Ombudsman shows some examples of typical waiting periods for major dental procedures like crowns, bridges, or orthodontics commonly incur waiting periods of up to twelve months.

Waiting periods for major dental procedures rely on a variety of factors and can vary between health funds, policies, and the type of procedure. This makes it even more important to compare health insurance policies to find the right fund or policy that offers extras cover with the shortest waiting periods for the major dental procedures that you may require.
Two dentist chairs

Why are there waiting periods for major dental extras cover?

Unfortunately, there is a good reason why most health insurers fail to provide major dental coverage with no waiting periods: it’s really expensive.

According to a 2016 survey from the Australian Dental Association (ADA), prosthodontics (the restoration and replacement of teeth) was the most expensive type of major dental surgery, with a denture (complete maxillary) averaging $1,250 and ranging from $943-$1,990, and a full crown (veneered – indirect) averaging $1,546 and ranging from $1,261-$1,945.

So, what would happen if there were no waiting periods for such expensive treatment? Without waiting periods, customers would be able to:

  1. sign up for cover;
  2. immediately claim on costly major dental surgery; and then
  3. cancel their health insurance policy before paying any premiums.

Health funds would be losing money by having to pay for the major dental procedure, without being compensated by the person who is having the major dental procedure or service over the course of the year (through premium payments).

As a result, the health fund would then have to increase insurance premiums for all other policy holders to compensate for its losses, which would put even more pressure on anyone who relies on private health cover.

Alternative options when you can’t get major dental health insurance with no waiting periods

No waiting periods for major dental are generally not an option with health insurance policies, although different health funds may offer a shorter waiting period than government standards in their policy, which means you wait less than the standard.

Health funds might also sometimes offer a waiting period waiver as a promotion when you compare health insurance policies and switch to their fund, to retain you as a customer, or for special circumstances. However, it is uncommon for a health fund to waive the 12 month waiting period for major dental services to be covered.

Should I get a major dental procedure done cheaper overseas without insurance, where there are no waiting periods?

Dental tourism has become a more popular option for consumers who want a major dental procedure done with no waiting periods. Australians are heading overseas to developing countries to save money on major dental as it can cost less, while having a holiday at the same time.

While this might seem like a cost-effective and time-saving option, dental procedures overseas are not bound by the same standards and regulations as dental surgery in Australia, which means:

  • you risk being treated by unregistered dental surgeons with less training, inferior equipment or inadequate facilities;
  • you risk infection, due to poorer hygiene and control standards;
  • your procedure has to fit in to your holiday period and you run the risk of rushing follow-up treatment/recovery and having a botched job (having to fit in all treatments and recovery in a couple of weeks instead of over months at home). This means you may need to have it fixed by a professional back home which can cost a lot more than what you initially budgeted for.

Dental tourism is a risk that may cost you more in the end than what it would to have the procedure done by a professional in Australia, which could be covered by health insurance if you stick out the waiting period – or even if you swallow the cost and pay for your procedure outright.

Is having health insurance with major dental cover worth the waiting period?

Paying dentist fees up-front can be quite daunting and costly, with major dental services having the capacity to dip into your savings. Although having no waiting periods for major dental procedures might sound ideal, introducing such a system would undoubtedly have an impact on the price of cover. According to the 2016 Dental Fees Survey Private Practice Members produced by the Australian Dental Association and ACA Research, the national average prices for major dental services by general practitioners around Australia (Appendix 5.1 of the report) are as follows:

a) Type of major dental serviceb) Price rangec) Average median price
Fissure/tooth surface sealing – per tooth$40-$86$58
Treatment of acute periodontical (gum) infection – per visit$61-$196$100
Tooth extraction/Removal of a tooth or part(s) thereof$135-$295$180
Veneer – direct$202-$597$348
Veneer – indirect$630-$1,740$1,100
Denture – complete maxillary$943-$1,990$1,250
Full crown – veneered – indirect$1,261-$1,945$1,546
Complete course of orthodontic treatment (usually 24 month waiting period as it is expensive)$1,000-$8,000$5,950

Prices in columns b and c according to Dental Fees Survey Private Practice Members – October 2016 (Appendix 5 General Practitioners – Mean, Range, Median Fees)

This table shows that major dental procedures can vary in price but are generally quite expensive. It just goes to show that the right health insurance policy can be truly fantastic value when certain procedures are needed.

The benefit of having major dental included in your extras policy is that it will generally allow you to claim back on these costs, by either a set percentage across the policy or a set dollar amount for each different dental item number or procedure.

There are annual limits for each extras benefit (or in some cases, limits for specific dental procedures), which means the maximum amount your health fund will pay towards your treatment will be capped.

The amount you receive back from your health fund per procedure will depend on:

  • the type of procedure (different types may have different rebate amounts);
  • your dentist’s charges (and any other specialist charges) for the major dental procedure; and
  • the specific rebate percentage or amount for major dental (or the specific procedure) stated on your policy’s PDS.

Although there are always waiting periods to be covered for major dental, the savings available through an extras policy is a benefit and definitely makes the wait more worthwhile.

Even if you don’t think you need major dental right now, it doesn’t cost very much to include coverage for it in your extras policy. This will allow you to have the peace of mind of knowing you are covered if major dental services are required in the future.

It’s important to take care of your pearly whites while you have them, so compare your health insurance options with Compare the Market today! There is no guarantee of having no waiting periods, but we make it easy to ensure you’re covered for the services you need, including extras that cover major dental.

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