Dental insurance in Australia

No, you typically can’t get major dental cover without serving the applicable waiting period. Although, if you are looking for dental cover you can use straight away, some health funds may offer a waiting period waiver as a promotion to new customers when you switch. That said, it is uncommon for a health fund to waive the 12-month waiting period for major dental services.

No, if you’re moving straight from an old to a new health fund and you’ve already sat your dental waiting period, you won’t have to wait again for the same treatments and services.

However, if you want to claim a treatment or service you weren’t previously covered for – or you want to enjoy higher claiming limits – you’ll have to sit your waiting period from the start for the additional benefits.

For example, say your previous health insurance policy only covered general dental, you move to a new health fund and find you need to have a crown done. In this case, you will have to sit your new health fund’s waiting period for major dental services as you did not previously have the coverage for this service.

It will depend on your policy; some health insurance policies offer higher dental claim limits than others. That’s why it’s so important to compare policies and look for those with generous claim limits on the services you need!

With extras policies, your dental cover may be subject to:

• Annual limits (e.g. $700 per year on dental);
• Sub-limits (e.g. maximum of $300 on major dental);
• Dollar limits per item number;
• Group limit with other ancillary services (e.g. a group limit to spend on all general dental, major dental and endodontic services); or
• Benefits can be paid as set benefits or a percentage back.

These limits mean your health fund will only cover up to the stated limit, and you will have to contribute the rest.

Here are some examples of claim limits for dental cover. Always check your policy documents to confirm your cover.

Some extras policies will impose lifetime limits on dental cover for particularly costly treatments; for example, you can only claim a certain amount on a dental insurance product for orthodontics for the entirety of your lifetime.

Extras policies are designed to contribute towards the expense of hospital treatments that Medicare doesn’t pay towards, dental included. In most instances, you will have out of pocket expenses. However, some dentists offer gap-free dental – where they charge only what the fund pays in benefit – so it’s worth talking to your dentist or checking your insurer’s website to see if they list any gap-free dentists.

For example, say your crown is going to cost $1,500, and your health insurance policy covers 60% of the cost up to an annual major dental limit of $1,200. In this instance you would receive $900 towards the crown for this treatment, meaning you would pay the remaining $600 out of your pocket.

Dental treatment can be expensive (especially major dental). However, the cost will vary based on which clinic you visit and which procedure you need.

Here’s an outline of what various dental services could cost without health insurance, based on the 2020 Survey of Dental Fees by the Australian Dental Association.³

Be aware that the prices below are just a guide based on our findings; your treatment may cost more (or less) than the prices outlined below.

If in doubt, ask your dentist for an itemised quote before making any appointments, and consider getting dental quotes from a few different dental clinics to compare if you have a lot of work to be done.

Source: ADA Dentist Fee Survey, 2020

Yes, health insurance contributes towards the cost of dental work with any qualified dentist. However, some health funds offer additional benefits such as no gap payment if you visit dental clinics or healthcare specialists they’ve partnered with or their own health fund owned dental clinic.

You should also look whether your fund accepts claims via HICAPS. This system enables the dentist to process your health fund claim on the spot rather than requiring you to pay the bill then claim back the benefit from the fund.

Kids may need braces (orthodontics), wisdom teeth removal or even a mouth guard moulded for sports. The good news is, dental cover can provide benefits for the entire family including your children.

Make sure your policy includes appropriate coverage for your child’s needs and review your cover often. There can be waiting periods for any additional coverage you add so change early to serve your waiting periods in time.

There is also the Child Dental Benefits Schedule (CDBS) scheme to consider, which sits outside of a private health insurance policy. It’s a service run by Medicare that provides eligible children up to a $1,013 benefit over 2 calendar years towards dental treatment. Eligibility criteria is based on families who are receiving selected government payments through Centrelink.

Read more about health insurance for children and dependents here.

Just like everyone else, Australian seniors can take out an extras policy with dental cover. Seniors often look for coverage toward major dental to make sure their policy includes dental insurance benefits for the things they may need later in life, like crowns or dentures.

Read more on seniors health insurance here.

If you’re an international student studying in Australia, your visa typically requires you to take out Overseas Student Health Cover (OSHC). OSHC doesn’t cover extras like dental, but you can take out an Extras OSHC policy from an OSHC provider, or you can purchase extras cover from any health fund in Australia (provided you meet requirements and submit all the necessary information).

Yes, provided that adequate cover is taken out, health insurance can cover cosmetic dental treatments to improve your appearance. Extras policies can potentially include dental insurance for:

• crowns (custom-made tooth cap)
• implants (replaces lost or missing teeth)
• veneers (bonding porcelain or resin)
• teeth whitening
• orthodontics (e.g. braces, dental aligners).

Your cover will vary depending on your health fund and policy. Check your policy brochure or call up your insurer to determine what cosmetic dental treatment it covers.

Yes, some extras health insurance policies can cover Invisalign treatment (i.e. clear aligners for teeth) under orthodontics, as it’s treated similarly to traditional braces. However, not all policies cover Invisalign treatment; even if they do, you will have to sit the waiting period for orthodontics.

If you’re getting health insurance just to get Invisalign treatment, make sure your policy covers it, and you’re aware of any limits and waiting periods.

Compare health insurance through our free comparison service today.

Dental tourism seems like a cost-effective and time-saving option for consumers who want a major dental procedure done with no waiting periods. However, dental procedures done overseas are not bound by the same standards and regulations as dental surgery in Australia, which means you risk:

1. Being treated by unregistered dental surgeons with less training, inferior equipment or inadequate facilities
2. Infection due to poor hygiene and control standards
3. A rushed follow-up treatment and recovery (because your procedure has to fit into your holiday period, instead of spreading it over a few months at home).

Dental tourism is a risk that may cost you more in the end than simply having the procedure done by a professional in Australia. Any treatments completed outside of Australia are also not claimable through a private health insurance extras policy.

¹Australian Institute of Health and Welfare 2021, Oral health and dental care in Australia. Accessed 25 October 2021.
² The Commonwealth Ombudsman – Waiting periods for private health insurance. Accessed 25 October 2021.
³ Australian Dental Association, Dentist Fee Survey, 2020. Accessed 25 October 2021.