Dental Insurance Basics


As far as Australians go, our oral health track record is far from ideal. Recent reports indicate that millions of us are living with untreated tooth decay and serious oral health issues. Part of the reason why a lot of Australians are missing out on essential dental care, maintenance and treatment from a dentist or hygienist is that when the unexpected happens, they’re just not financially prepared.

90,000 Australians on public dental waiting list

While public dental care is available, you’ll be put on a two or three year waiting list that – as of November 2019 – stands at almost 90,000. Given a few years, an oral problem can easily progress from a mild condition to a more severe one requiring even more complex and potentially costly treatment. For many, time is running out.

However, there is one way to ensure that you’ll be able to cover your dental fees (partially or completely) when the need arises – dental insurance. Dental insurance can help safeguard your oral healthcare needs when unexpected dental problems and issues occur.

How does dental insurance work in Australia?

In general, there are no stand-alone dental insurance products in Australia. Typically, you will need to take out private health cover for starters, after which you can select extras (ancillary) cover for dental. Extras cover covers services such as dental, physiotherapy, remedial massage and optometry.

Types of dental extras cover

Extras cover basically provides two levels of dental cover:

  • General dental covers preventative dental treatments such as check-ups, dental cleaning, bite-wing x-rays and minor fillings. Young adult singles and couples in good oral health would find this level of coverage suitable to their dental needs.
  • Major dental covers more complex dental treatments such as crowns, bridges, root canal treatment (endodontic treatment) and braces (orthodontic treatment). Older adults with a history of oral issues and families with children may benefit more from this level of cover.

* Cosmetic dental treatment such as teeth whitening and veneers are usually not covered by private health funds.

Out-of-pocket expenses for dental treatment

Depending on your insurance provider, you can receive 100% back on dental fees for preventative dental treatment such as check-up and cleans. However, there are usually limits to what you can claim off major dental treatment. In this case, you would have to make up the difference between your rebate and the treatment costs. This is known as “the gap”. The only way to avoid gap payments is to pay higher premiums that offer more attractive rebates.

Waiting periods & annual limits for dental cover

As with hospital cover, when you initially purchase extras cover, you’ll have to sit out a mandatory waiting period before being able to claim any dental benefits. For general dental, you usually have to wait two months. For major dental, it’s twelve months, and for complex, costly dental treatment such as orthodontics and dental implants; you may have to wait between one to three years.

Compare the market for a health fund that suits your oral health needs

It’s worth taking some time to compare the market, when it comes to choosing a health fund that suits your needs and budget. Each health fund is different with its own pros and cons with regard to your personal oral health situation.

All private health insurers in Australia are required to provide their health insurance policy details to the Australian Government by law. So, if you what to find a health fund that caters for the future needs of you and your loved ones, then start comparing policies at the unbiased Australian Government insurance comparison website: