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Looking after your teeth can be expensive. Data from the Australian Institute of Health and Welfare (AIHW) shows that one-fifth of Australians over 15 avoided or delayed going to the dentist due to cost in 2019-20.1

Maintenance from a dental professional is crucial to protect those pearly whites, but it doesn’t have to cost you an arm and a leg. A health insurance policy with good dental benefits can help maintain your oral health.

So, what private health insurance options are available to you, what is dental insurance and is it worth it?

What is dental insurance, and can I get dental insurance only?

You’re unlikely to find a standalone dental insurance policy in Australia which only covers dental, and hospital cover will also not include dental in most cases. Private hospital policies can help pay towards in-hospital dental treatment and operations such as day surgeries for wisdom tooth extraction, but overall, dental is a benefit predominantly covered by extras health insurance.

Extras health insurance policies can include 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 plates.

This dental cover will help pay toward the treatment performed in the dental surgery.

You can have a combined hospital and extras health insurance policy that includes dental cover alongside other benefits from both types of policies.

Which dental services does extras insurance cover?

If you require dental treatment, private health insurance can provide varying levels of coverage to match your needs and contribute to the cost of dental treatments.

Extras policies typically include a range of services which can be categorised into four main groups: General Dental, Major Dental, Endodontic and Orthodontics. Your level of cover will determine what exactly is included in your policy.

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 for general dental treatments by taking out an extras policy and serving any applicable waiting periods prior to undergoing any treatments.

Major Dental generally covers more complex treatment, such as:

  • Tooth extraction: tooth removal due to decay or damage (can be basic dental or major dental depending on specific item numbers the dentists use and the policy you are on).
  • Wisdom teeth removal: removing wisdom teeth if they damage surrounding teeth or gums (can be basic dental or major dental depending on specific item numbers the dentists use and the policy you are on – at times this can also be performed in a hospital and may require private hospital insurance).
  • Complex fillings: treatment of tooth decay and damage.
  • Crowns and bridges: dental implants for a single damaged tooth or multiple teeth.
  • Veneers: thin implants that cover the front of the tooth, generally cosmetic.
  • Dentures: removable prosthetic teeth.

Endodontic is the practice of treatment for the soft tissue of teeth including:

  • Root canal therapy: endodontic procedure to dig into a cracked tooth and extract inflamed tissue.
  • Periodontics: treatment of gum tissue diseases like gingivitis, infection, and inflammation.

Orthodontic work meanwhile is the process of correcting teeth/jaws that aren’t in the right position, usually with braces or Invisalign.

Depending on your level of cover, 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.

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.

It’s important to review your policy regularly to see whether you have the most relevant cover for your circumstances.

Does health insurance cover dental surgery in a hospital?

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.

man-and-woman-visiting-dental-clinic-asking-how-much-they-can-claim-on-dental-insurance

How long will I wait before I can claim on dental health insurance?

The amount of time you’ll have to wait before being able to claim on dental benefits 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 months12 months12+ 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, endodontic or orthodontic procedure done, you’ll generally have a twelve-month waiting period before you can claim for 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.

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.

Dental insurance: Frequently asked questions

Can I get major dental coverage with no waiting periods?

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.

Do I have to re-sit my dental waiting period if I change health funds?

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.

How much can I claim on dental cover, and are there limits?

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.

General dental treatmentClaim limit ($) or percentage rebate range
Oral examination$14 – $3460% – 70%
Scale and clean$28 – $7460% – 70%
Fluoride treatment$14 – $2560% – 70%
Annual limit per policy$600 – $1000
Major dental treatmentDollar limit or percentage rebate
Surgical tooth extraction (may be included in general treatment)$62 – $13260% – 70%
Full crown – veneered$500 – $65060% – 70%
Annual limit per policy$500 – $1000
Examples based on extras policies from insurers on Compare the Market’s health insurance panel. Assessed 25/10/21.

Will I have any out-of-pocket dental expenses?

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.

How much does dental treatment cost?

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.

Dental procedure/serviceAverage cost (rounded to the nearest dollar)
X-ray$44
Oral examination$65
Oral consultation$76
OPG radiograph / X-ray$126
Scale and clean/polish (removal of calculus)$140
Filling – Dependent on item numbers and number of surfaces requiring filling.$221
Check-up, clean & fluoride (package)$225
Custom mouthguards$230
Tooth extraction$235
Check-up, clean, fluoride & x-rays (package)$287
Veneer – composite (per tooth)$397
Teeth whitening (take home kit)$406
Wisdom tooth extraction (single or lower tooth only)$442
Root canal work/therapy (endodontics) – depending on front or back$1,233
Veneer – porcelain (per tooth)$1,287
Crown (full)$1,545
Full dentures$2,533
Dental implant$4,325
Braces/Invisalign (orthodontics)$6,330

Source: ADA Dentist Fee Survey, 2020

Does health insurance cover visits to any dentist?

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.

How does dental insurance work for kids?

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.

How does dental insurance work for seniors?

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.

How does dental insurance work for international students?

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).

Does health insurance cover cosmetic dental surgery?

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.

Does dental insurance cover Invisalign?

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.

Can I get a major dental procedure done overseas with no waiting period?

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.

Anthony Fleming, General Manager

Meet our health insurance expert, Anthony Fleming

As General Manager for Health and Life Insurance at Compare the Market, Anthony Fleming’s passion lies in helping Australians find the right products for their needs.

Take dental cover, for example, which can be purchased through your extras policy. In Anthony’s opinion, dental cover is essential, as most dental bills aren’t covered in the public system. With the appropriate extras policy in place to cover preventative measures (such as regular dental check-ups), you could avoid more costly issues in the long run.

Anthony has spent close to 20 years in the industry and is a Board Member of the Private Health Insurance Intermediaries Association. You’ll often find him in the press and on television helping Australians better understand what can be a fairly daunting subject.

Anthony’s top tips for dental insurance:

  1. You’ll be glad to know that with dental insurance you are free to visit any qualified dentist of your choice. When considering your options, it is worth knowing that some health funds have preferred dentists that they have agreements with. These agreements usually provide members with more transparent pricing before seeing the dentist, reduced costs due to better negotiation and in some cases, you may even receive gap-free treatment.
  2. The amount you get back on your dental work can vary from fund to fund. Some policies provide percentage back refunds for your dental bills, up to an annual limit. Compared to others who provide fixed-dollar benefits. If your dentist is more expensive than others, the percentage option may be more in your favour.

How to find dental cover that puts a smile on your face

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!

Sources

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.

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