Have you ever had terrible tooth pain, but put off going to the dentist because of how much it would cost? Well, you’re not alone.
Almost three in five Australians delay dental treatments due to their expense, according to our survey of 1087 Australians regarding dental visits, conducted by market research company Pureprofile in December, 2018.
Maintenance from a professional is crucial to protect those pearly whites, but it doesn’t have to cost you an arm and a leg.
So, what private health insurance options are available to you, and is dental insurance worth it?
Extras health insurance policies typically includes a range of dental services from general and routine dental such as cleans, scales, fillings and extractions to major dental such as crowns, bridges and dentures or partial plates. This dental cover will help pay toward the treatment performed in the dental surgery. Furthermore, private hospital policies can help pay towards in-hospital dental treatment and operations such as day surgeries for wisdom tooth extraction. However, you’re unlikely to find a standalone dental insurance policy in Australia which only covers dental.
If you require dental treatment, private health insurance can provide varying levels of coverage to match your needs and contribute towards the cost of dental treatments.
Extras policies typically include a range of services which can be categorised into two main groups: General Dental and Major Dental including both Endodontic and Orthodontics.
General dental helps pay for preventative treatment services like oral exams, scale and cleans, simple fillings, mouthguards, x-rays, tooth extractions and even teeth whitening in some cases. You can gain cover towards general dental treatments by taking out an extras policy and serving any applicable waiting periods prior to undergoing any treatments.
Major Dental including both Endodontic and Orthodontics generally covers more complex treatment, such as:
Depending on your level of coverage, you may not have access to all these treatments and services; more complex dental treatment (e.g. orthodontic or endodontic) may only be covered through higher-level extras policies. Conversely, as extras policies differ from fund to fund, treatments that are generally covered under Major Dental could be covered under General Dental instead and vice versa. This can affect your waiting periods as some of these treatments will have longer waiting periods than others. It’s important to review your policy brochure to know for sure.
Yes, health insurance can cover dental surgery in a private hospital (e.g. surgery to remove wisdom teeth or dental implant surgery). These procedures are covered under hospital insurance, not extras insurance. Also, dental surgery is typically covered under Bronze Plus, Silver or Gold category health insurance policies.
The amount of time you’ll have to wait before being able to claim dental will vary depending on which health fund (i.e. insurer) you’re with and what treatment you’re claiming on.
Each health fund sets its own waiting periods for extras policies. Here’s how long typical waiting periods might be for dental cover:
|2 months||12 months||12+ months|
|General dental will typically have a two-month waiting period, which means you may have to wait two months after taking out your policy if you want your health insurance to help pay for your clean, scales or fillings.||If you want to get a major dental procedure done, you’ll generally have a twelve-month waiting period before you can claim major dental treatments on your health insurance policy.||Some higher-cost procedures like orthodontics and braces may have a twelve-month wait or can even stretch to two or three years.|
|Source: The Commonwealth Ombudsman – Waiting periods for private health insurance, accessed 23/12/2019|
It’s essential to take out cover well in advance so that you’ve served those waiting periods by the time you start to experience any issues. When comparing and purchasing extras health insurance, make sure you confirm your applicable waiting periods.
No, you typically can’t get major dental cover without serving the applicable waiting period. Although, if you are looking for dental insurance 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 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 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:
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:
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.
|General dental treatment||Claim limit ($) or percentage rebate range|
|Oral examination||$14 – $34||60% – 70%|
|Scale and clean||$28 – $74||60% – 70%|
|Fluoride treatment||$14 – $25||60% – 70%|
|Annual limit per policy||$600 – $1000|
|Major dental treatment||Dollar limit or percentage rebate|
|Surgical tooth extraction (may be included in general treatment)||$62 – $132||60% – 70%|
|Full crown – veneered||$500 – $650||60% – 70%|
|Annual limit per policy||$500 – $1000|
|Examples based on extras policies compared on Compare the Market on 18 December 2019|
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.
For example, say your crown is going to cost $1,500, and your health insurance policy only covers 60% of the cost up to an annual major dental limit of $1200. 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.
We sourced available prices from 10 dental clinics around Australia in December 2019 to try and figure out the average cost of dental procedures in Australia.
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.
Here’s an outline of how much dental services could cost without health insurance:
|Dental procedure/service||Potential costs (rounded to the nearest dollar)||Average cost (rounded to the nearest dollar)|
|X-ray||$39, $40, $45, $50||$44|
|Oral examination||$52, $57, $65, $85||$65|
|Oral consultation||$65, $80, $83||$76|
|OPG radiograph / X-ray||$100, $125, $152||$126|
|Scale and clean/polish (removal of calculus)||$98, $115, $145.45, $150, $165, $169||$140|
|Filling – Dependent on item numbers and number of surfaces requiring filling.||$170|
|Check-up, clean & fluoride (package)||$202, $219, $255||$225|
|Check-up, clean, fluoride & x-rays (package)||$179, $292, $319, $359||$287|
|Veneer – composite||$380|
|Teeth whitening (take home kit)||$299, $440, $450, $474, $499, $400, $360, $380, $350||$406|
|Wisdom tooth extraction (single or lower tooth only)||$350, $425, $550||$442|
|Root canal work/therapy (endodontics) – depending on front or back||$600-$1,200 (median=$900)|
|Veneer – porcelain||$1,160|
|Full dentures||$2000-$2600 (median=$2300)|
|Dental implant||$2,000-$2,600 (median=$2,300)|
|Prices accurate as of 19 Dec, 2019; sourced from:|
Yes, health insurance contributes towards the cost of treatment 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 into whether your fund accepts claims via the Health Industry Claims & Payments Service, or 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.
Dental cover can provide benefit for the entire family including your children; kids may need braces (orthodontics), wisdom teeth removal or even a mouth guard moulded for sports. 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.
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.
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:
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.
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:
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 not claimable through a private health insurance extras policy.
Are you wondering how much an extras policy including dental insurance in Australia costs?
Our health insurance comparison service allows you to compare dental insurance quotes online and easily see which policies (a) cover major dental procedures and (b) have more generous limits for services you’ll utilise.
If you’d prefer to talk to someone, call one of our health insurance consultants and we will help you find a policy that has a level of dental cover you’re happy with.
It’s time to make going to the dentist a little less scary – for your wallet, at least!