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Does Medicare cover dental treatment?
Here's how dental treatments are covered by Medicare in Australia.
Dental treatments are normally only covered by Medicare if they are considered essential for the patient's wellbeing. While some dental procedures are covered, most general dental examinations and treatments are not. This guide looks at who is eligible and explores some potential solutions through private cover that may not cost as much as you think.
Does Medicare cover dental in Australia?
Medicare only covers certain essential dental procedures, the Federal Government does provide funding for dental treatment for eligible children and adults through schemes such as:
- Child Dental Benefits Schedule. This provides benefits for basic dental services for children aged 2 to 17 years who are eligible for Medicare and who receive certain government benefits such as the Family Tax Benefit Part A. The benefits are capped at $1,000 per child every two years and they cover services such as examinations, x-rays, cleaning, fissure sealing, fillings, root canals and extractions.
- Child and Adult Public Dental Scheme. As of early 2017, this scheme provides ongoing joint funding with the states and territories to assist them with providing public dental services for children, as well as for adults with concession cards.
The aim of these initiatives is to try and improve the oral health of those Australians who cannot afford private health insurance. Those who can afford it have access to dental treatment through extras cover, which provides different levels of cover from general preventative dental treatment through to major dental procedures and orthodontics.
Extras cover can be a great way to cover your dental expenses and can help you skip the Medicare queue if you're in a little pain.
We’ve rounded up a few of the basic level dental policies from Finder partners. They all have a general dental limit which includes annual check-ups, minor extractions, dental x-rays, minor fillings and teeth cleaning. All these options have a 2 month waiting period.
|Provider||Policy||Limit||Price per month||Apply|
|Black 50 saver (includes no gap dental check-ups)||$400||$12.85||Go to Site|
|Starter Extras (100% back on one dental check per year)||$350||$12.25||Go to Site|
|Core Extras (60% back on each visit, up to your annual limit)||$600||$30.26||Go to Site|
*Quotes are based on single individual with less than $90,000 income and living in Sydney.
The dental procedures that are and are not covered by Medicare include the following:
- Diagnostic. These procedures are normally covered if a medical practitioner needs to perform a specific procedure to diagnose a dental issue (e.g. a dental X-ray).
- Preventative. Procedures such as cleaning and scaling are covered up to certain limits for eligible groups because they prevent larger, more expensive dental issues from developing later on in life.
- Oral surgery. Surgery of the mouth or teeth is only covered in a limited capacity for specific oral surgeries required for particular purposes.
- Restorative. This is normally partially covered, although waiting limits and some out-of-pocket expenses may apply and it is not covered in all states and territories.
- Cosmetic. Dental procedures for mainly cosmetic purposes are usually not covered, although those for necessary purposes that happen to have cosmetic benefits are more likely to be covered.
Each state and territory has its own public dental program and the following breakdown summarises the schemes available along with eligibility requirements, fees payable and where participating clinics can be found.
Private health insurance can provide additional cover for a broad range of dental expenses under both general and major dental cover in extras cover. The table below shows the types of treatments typically covered under each. Please note this list is not exhaustive and treatments can vary depending on the policy you choose.
|General dental||Major dental|
What are the Medicare dental procedure conditions for all the Australian states?
Medicare dental cover in NSW
NSW provides public oral health care to eligible people within Local Health Districts. Services include general dentistry (e.g. examinations, fillings and dentures) and are provided in clinics based in community health centres, hospitals and schools in metropolitan areas, and hospitals, schools, community health centres and mobile dental clinics in regional areas.
Adults must be over 18, eligible for Medicare and hold or be listed as a dependent on a Health Care Card, Pensioner Concession Card or Commonwealth Seniors Health Card. Children must be under 18 and eligible for Medicare.
- Benefits for children
Children in NSW may be eligible for the Commonwealth-funded Child Dental Benefits Schedule (CDBS), which provides up to $1,000 in benefits per child for general dental services over two consecutive years.
To help deliver priority dental treatment, the NSW Oral Health Fee For Service Scheme (OHFFSS) allows eligible patients to seek treatment from private dental practitioners. They are issued with a voucher, which they can take to a participating dentist to receive the same treatments provided in a public clinic. Fees are only payable if additional non-approved treatments are performed.
The list of Local Health Districts in NSW and the contact phone numbers for their respective Oral Health Call Centres can be found at the Health NSW website.
Medicare dental cover in the ACT
The ACT provides a variety of public dental services to eligible groups including child and youth dental services, adult dental services, emergency dental services and a range of denture services.
To be eligible for these services, children under 14 years must live in the ACT or be attending an ACT school, and young people over 14 and adults must have access to a Centrelink-issued Pension Concession or Health Care Card.
- Benefits for children
The ACT’s Child and Youth Dental Scheme provides children and young people with dental services including assessment, oral health plans, general preventative and restorative treatment, and emergency dental treatment. It is available to children under 5 who live in the ACT, children 5 to 14 who live in or attend school in the ACT, and young people under 18 who live in or attend school in the ACT and are covered by a Centrelink Concession Card.
For adult dental treatment, there is a maximum co-payment of $300 a year for restorative treatments, apart from molar endodontics, general anaesthetic and dentures. For children’s dental treatment, a standard fee of $63 per child per course of care applies for children up to the age of 14.
There are public dental service locations for adults and children throughout the ACT including clinics in Belconnen, Canberra City, Gungahlin, Phillip and Tuggeranong. You can access their contact information at the ACT Health site.
Medicare dental cover in QLD
Queensland Health provides public dental services to eligible adults, adolescents and children through public sector dental clinics located throughout Queensland.
Adults must be residents of Queensland receiving benefits from either a Pensioner Concession Card issued by Centrelink or the Department of Veterans’ Affairs, a Health Care Card, a Commonwealth Seniors Health Card or a Queensland Seniors Card.
Children are eligible if they are named as a dependant on any of these cards or if they are in the guardianship of the Director-General, the Department of Families or Youth and Community Care.
- Benefits for children
Queensland Health provides publicly funded oral health care for children via its Child and Adolescent Oral Health Services. All children four years and over who have not completed Year 10 of secondary school are eligible. Children in Queensland may also be eligible for the Federal Government’s Child Dental Benefits Schedule (CDBS), which provides up to $1,000 in benefits per child for general dental services over two years.
Public sector oral health services are funded by the Queensland Government and are provided at no charge to eligible patients.
Public oral health services are provided through a range of mobile, school and community dental clinics and you can locate your nearest clinic by going to Queensland Health.
Medicare dental cover in WA
The WA Government Department of Health provides subsidised dental care to eligible patients in the Perth metropolitan area and a number of country locations, with eligible patients being placed on a Public Dental Clinic waiting list.
To be eligible, adults must hold a Health Care Card or a Pensioner Concession Card, while all school children aged 5 to 17 (or until they finish Year 11) are eligible for the School Dental Service program.
- Benefits for children
The WA Government’s School Dental Service program provides free general dental care to WA school children from pre-primary through to Year 11, and to Year 12 in remote locations. It is a public dental health program with an emphasis on prevention and education, and treatment is limited to general practice care only.
Emergency or general dental care at a Public Dental Clinic or participating private dental practitioner attracts a fee, which is subsidised by the government up to a maximum of 75% of the cost of treatment.
You can find a list of contact details for public dental clinics in your area of WA by going to the Government of Western Australia Department of Health, Dental Health Services.
Medicare dental cover in the NT
The NT Government’s OHS-NT provides oral health services to eligible patients, including pain and trauma management, emergency care, restorative fillings and repairs, endodontics, extractions, oral hygiene, oral health promotion and denture services. They also provide specialist services including orthodontics, oral surgery and treatment in hospital under general anaesthetic.
Adults must hold a Centrelink Pensioner Concession Card or Health Care Card and all children up to the age of 18 are eligible for free dental services through school-based and community clinics and mobile services.
- Benefits for children
OHS-NT provides services to NT children under 18 through the Child Oral Health Service. Services are provided at primary school-based clinics and community dental clinics in urban areas, and at community health centres and mobile clinics in rural and remote areas.
Dental services are provided free to eligible adults and children, although waiting lists may apply and patients are prioritised according to urgency.
For the contact details of dental clinics in Darwin, Palmerston, Alice Springs and Tennant Creek, plus community clinics in remote areas, go to the Northern Territory Government Department of Health website.
Medicare dental cover in TAS
Oral Health Services Tasmania provides dental services to eligible patients including priority care, general care (check-ups, fillings, extractions, etc.) and denture services.
Adults must hold a Health Care Card or a Pensioner Concession Card and all children under 18 years of age are eligible, including preschoolers.
- Benefits for children
Oral Health Services Tasmania provides free dental care for children up to 18 years of age, which includes dental check-ups and any necessary treatment determined by the check-up, plus X-rays, dietary advice, oral hygiene instruction and referral for further assessment or treatment if required.
All adults are required to pay a co-payment towards the cost of their dental care, but almost all treatment for children is free if bulk-billed.
Services are provided from dental centres in Burnie, Devonport, Launceston, Clarence and Hobart, plus additional locations around the state for children and adolescents. You can find a full list of locations on the Tasmanian Government Department of Health and Human Services website.
Medicare dental cover in VIC
The Victorian Government’s Dental Health Program provides public dental care to eligible patients. Services include both routine and urgent dental care and are provided through the Royal Dental Hospital Melbourne and 79 clinics across the state, operated by community health and rural public health services.
Adults must be 18 and over and hold or be listed as a dependant on a Health Care Card or Pensioner Concession Card. All children up to 12 years are eligible, plus young people aged 13 to 17 years who hold or are dependants on a Health Care or Pensioner Concession Card.
- Benefits for children
Children in Victoria may also be eligible for the Commonwealth Child Dental Benefits Schedule (CDBS), which provides up to $1,000 per child for general dental services over two years.
Fees may apply to patients 18 and over who hold or are listed as a dependant on a Health Care Card or a Pensioner Concession Card, and children up to 12 years who do not hold a concession card or are not dependants of concession card holders.
Exemptions include Aboriginal and Torres Strait Islanders, the homeless, refugees, asylum seekers, children and young people up to 18 years old in out-of-home care or youth justice custodial care, people registered with mental health and disability services and those experiencing financial hardship.
There are more than 80 community dental clinics located throughout metropolitan Melbourne and rural Victoria and you can find a clinic near you by visiting the Dental Health Services Victoria.
Medicare dental cover in SA
The SA Dental Service provides a range of dental services for eligible adults and all children under 18 years of age at school and community clinics throughout SA and at the Adelaide Dental Hospital.
Adults must hold a Health Care Card or a Pensioner Concession Card issued by Centrelink or the Department of Veterans’ Affairs, and all children under 18 years of age who live or go to school in SA are eligible for the government’s School Dental Service.
- Benefits for children
The School Dental Service offers dental services for all children under 18 years of age who live or go to school in SA. Services are provided by teams of dentists, oral health therapists and dental assistants at clinics throughout SA, and dental care is also provided free for babies and preschoolers.
Adult concession card holders contribute towards their dental care by paying a client fee. Currently, this is $59 for emergency dental care and up to $155 for general dental care. Fees are also payable for dentures and denture repairs.
You can find a full list of dental clinics in SA by location for both children and adults at the SA Health website.
Medicare dental Australia eligibility
The National Partnership Agreement on Public Dental Services for Adults was set up in 2017 to provide Australian states and territories with additional funding and support for public dental care. This entitles those who need it to cheap or free public dental care. Eligibility for public dental services often includes the following requirements:
- You must live within the boundary limits of the Local Health District that is providing the care.
- You must be eligible for Medicare e.g. an Australian citizen or permanent resident.
- You must be at least 18 or older.
- You must hold, or be listed as a dependent on, a valid Australian Government concession card. This includes a Health Care Card, Pensioner Concession Card or Commonwealth Seniors Health Card.
- You may be eligible if you have a State Seniors Card but you usually need to hold one of the other concession cards as well.
Eligibility differs from state to state so be sure to visit your State Health Department's website. Be aware also that as a result of limited resources and available services, there may be significant waiting times.
Medicare dental benefits
The Child Dental Benefits Schedule (CDBS) and Public Dental Scheme
gives eligible children and adults access to a range of benefits that otherwise wouldn't be available to Australians. Some of the benefits and exclusions for the CDBS and Public Dental Scheme include:
- Dental examinations
- Repairing cracked teeth
- Routine cleaning
- Fillings & Root canals
A benefit will generally not be paid towards:
- Orthodontic treatment such as braces
- Any dental treatment that has to be done in hospital
- Cosmetic dental procedures
Where to find Medicare dental schemes for adults
Local Health Districts (LHD) usually operate public dental services. They usually include free general dental for services like examinations, dentures and fillings. Depending on the state and territory you live in (as well as your eligibility) you can often find dental services in the following places:
- Schools, community centres or mobile dental clinics. Regional LHDs are sometimes run in schools or mobile dental clinics so as to make them easier to access in remote communities.
- Hospitals. In more remote communities, it's often the case that public health services are done in hospital. Although some are in hospital, this does not mean you are not covered. Cover depends on what treatment you are receiving.
- Private surgery. In some areas, a private surgery might be rented out by a public dental scheme to provide oral health services.
To find out more about where to find Medicare dental care, visit your our State Health Department's website.
Do dentists bulk bill?
It's possible to find bulk-billing services for preventative dental check-ups and treatments at some dental practices. Bulk Billing dentists are available to those holding a Medicare Card and one of the following:
- Health Care Card
- Pensioner Concession Card
- Commonwealth Seniors Health Card
You can also get bulk billing through the Child Dental Benefit Scheme. If you qualify for this scheme, you just need to take your Medicare card to your appointments and the dental service will process your claim for you.
How to find a bulk billing dentist
Not all dentists bulk bill so you'll need to do a bit of research depending on where you live. Finding one can be difficult as the health service tool currently doesn't show any bulk billing dentists.
However, when you go to make an appointment, you should ask the dentist if they do bulk billing. If you are claiming services covered by a dental benefits scheme, such as the Child Dental Benefits Schedule (CDBS), the claim should be bulk billed and there will be no out of pocket expenses.
Otherwise, you may have to claim your benefit directly from Medicare if the dentist doesn't bulk bill. This will mean you have to pay the initial fee, though you will be reimbursed, so if this isn't an option, be sure to search for a dentist that bulk bills.
Use the free comparison tool to compare dental options
Think you may need something a bit more comprehensive? Or want to grab a few extra health perks? Simply enter your details on our health insurance tool.
For dental only, select extras then hit Search Policies. You can use the filters to sort policies by general dental, major dental, endodontic and orthodontic limits.
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