Extras cover is the only way most people will get cover for emergency dental work because the public health system only covers certain groups like children, seniors and low-income families, and, in some rare cases, emergency treatment in a normal (i.e. non-dental) hospital.
With a private extras policy, your insurer will pay up to 80% of your treatment cost, plus you'll have access to other benefits like regular dental check-ups, natural therapies and more.
Emergency dental care refers to any dental treatment that requires immediate attention. It can include medical emergencies like trauma to the face and jaw, but it doesn't always have to be a medical emergency. For example, broken dentures can be considered an emergency since some people require them to be able to eat.
Common examples of dental emergencies include the following:
It is very rare for Medicare to cover dental treatments including emergency care. There are only three situations in which Medicare will cover you:
Most states also have public dental benefits, but they usually prioritise certain groups like children, the elderly, the homeless and low-income families. If you are eligible for emergency dental benefits through your state, you will most likely have to visit a public dental facility and may have to join a queue if your condition is not life-threatening.
Here are the benefits available in each state:
In NSW, emergency dental care is free for the following people:
You must also have a valid Medicare Card and get your treatment at a NSW public dental clinic.
The following groups are eligible for free emergency dental care in a VIC community health centre or public dental hospital:
Adults who have a valid Health Care or Pensioner Concession Card will receive emergency dental care in a community health centre or public dental hospital for $28.50. Everyone else can use the public facilities, but you'll be charged rates that are similar to what you'd find in a private facility.
The following groups can receive free publicly funded emergency dental treatment in QLD:
You must be a QLD resident and you must receive your treatment in a public dental facility.
The following groups are eligible for publicly funded emergency treatment in WA:
You must receive your treatment in a public dental facility. If you live in a rural community and don't have access to a private clinic, you can use a public clinic but you will have to pay full price for treatment.
If you belong to one of the following groups, you are eligible for publicly funded dental treatment in SA:
You must have your treatment in a public facility.
The following groups are eligible for publicly funded dental treatment in TAS:
You must visit a public dental facility to be eligible.
Unless you are one of the very few people who are eligible for public assistance, private health insurance is the best way to get cover for emergency dental treatment. Private insurers cover dental work as part of their extras policies (as opposed to hospital policies).
Here's what to look out for when choosing an extras policy:
Your insurer will pay a percentage of your treatment cost up to your yearly benefit limit. The percentage they'll pay varies from insurer to insurer, but will usually be anywhere from 60-80%.
Don't forget to select dental under 'What's most important to you?'
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If you think you need emergency dental work, the first things you need to do are get yourself out of immediate danger and take steps to minimise long-term damage to your teeth, gums and jaw.
Here's what you need to do:
If your emergency is so severe that you need an ambulance, there is a good chance they will take you directly to a dental hospital, which is better equipped than a family dentist to handle surgeries and other complex treatments.
If you don't need an ambulance, you should see your family dentist who will be able to take care of some emergency procedures and refer you to a dental hospital if necessary.
If you're eligible for emergency dental treatment through your state's public health system, you may need to be treated in an authorised community health centre (in place of the family dentist) or the local public dental hospital (in place of a private dental hospital). So if you can, mention to your dentist or ambulance driver that you'd rather be treated in a public facility.
If you use a public dental facility for your emergency dental treatment, your costs will differ based on what state you are in and your eligibility threshold in that state. If you are eligible for publicly funded emergency dental treatment in your state, it could be free or you could end up paying a small fee.
If you are not eligible for public benefits in your state (most adults and a large proportion of children in each state), you will most likely need to visit a private clinic for your treatment.
A private clinic can charge you whatever they want for your treatments. If your private health insurance covers your emergency dental treatment, it will pay a percentage of your costs up to your benefit limit.
The following table shows how much you would pay for a hypothetical root canal and how it would affect your benefit limits, based on an insurance policy that covers 70% of your treatment costs and has a $1,000 benefit limit.
You may be able to do these calculations yourself for your actual treatments. Just ask your dentist to itemise your treatment costs upfront so you'll have the figures to work with. Keep in mind that they won't always be able to predict exactly what you will need without seeing your teeth first.
| The cost of your root canal | The amount your insurance pays | The amount you pay |
|---|---|---|
| $600 | $600 x 70% = $420 | $600 x 30% = $180 |
| Your dental benefit limit before your root canal | The amount your insurance paid toward your root canal | Your new dental benefit limit |
|---|---|---|
| $1,000 | $420 | $1,000 - $420 = $580 |
Bulk billing is only available when a Medicare-approved treatment is involved. That means the only time bulk billing occurs is when a child is treated under the Medicare Child Dental Benefits Schedule (CDBS). Some private and public dentists and dental hospitals will bulk bill for services under the CDBS to help disadvantaged children avoid out-of-pocket costs.
Picture: Unsplash
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