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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.
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:
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.
Need your check up asap? Extras can be a good option. With the Lifestyle Extras plan from ahm, there's no waiting period on general dental from $52.05 monthly. You get other discounts with that too including physio and new glasses.
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.
The dental procedures that are and are not covered by Medicare include the following:
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 |
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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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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:
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.
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:
A benefit will generally not be paid towards:
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:
To find out more about where to find Medicare dental care, visit your our State Health Department's website.
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:
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.
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.
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.
Picture: GettyImages
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My child has to have root canal treatment, the estimated cost is over $3000 dollars, we simply can not afford it, he is only 12. Is it possible to get this done through Medicare/bulkbilling
Hi Chantel,
Thank you for getting in touch with Finder.
The Child Dental Benefits Schedule (CDBS) only covers up to $1,000 over 2 calendar years for basic dental services like root canals. You may check out this page for more info on this matter.
I hope this helps.
Thank you and have a wonderful day!
Cheers,
Jeni
I would like to know if the government dental services are as good as the private dentists. I am nervous about going to the dentist, so it’s a big decision for me
Hi Chantal,
Thank you for getting in touch with finder.
Please note that each state and territory has its own public dental program that you may benefit from while private health insurance can provide additional cover for a broad range of dental expenses under both general and major dental cover in extras cover. You may visit the Department of Health page and click on your state to learn more on the dental program, eligibility as well as to find your nearest public dental clinic you may have your oral check up with.
I hope this helps.
Thank you and have a wonderful day!
Cheers,
Jeni
Hello. My 16 yo needs a root canal. I believe this was to be covered by Medicare under Labor’s retained state gov in Victoria.
Can you tell me more? Do we access this through an endodontist our general dentist?
Hi Bee,
Thank you for getting in touch with finder.
All children and young people up to 18 years of age, who are in out-of-home care provided by the Children Youth and Families Division of the Department of Human Services are eligible for dental treatments including root canals as per this Dental Health Services Victoria page. You may contact them directly for further clarification on this matter on 1300 360 054 from Monday to Friday, 8AM to 830PM.
I hope this helps.
Please feel free to reach out to us if you have any other enquiries.
Thank you and have a wonderful day!
Cheers,
Jeni
Hello,my daughter had a dental surgery last month which costed 2,300.she had four crowns and filling plus an extraction.i dont know if i can claim some money back from medicsre.thanks
Hi Chantel,
Thank you for reaching out to finder, a comparison website.
You may need to reach out directly to Medicare regarding this query to ensure that they know what type of surgery was done. This will also give you a better idea of what Medicare could cover based on the surgery done to your daughter. Hope this helps!
Cheers,
Reggie
I am an aged pensioner,i do not have any form of private health cover.Recently i had an abscess on a bottom back tooth.Whilst i was able to claim the visit to the g.p.for the antibiotics to fix the infection .I am wondering wether i can claim the actual dental work the root canals necessary to prevent further problems .the actual cost for the procedure was over $1000 .can i claim some of this cost through medicare
Thank you
Hi Tim,
Thank you for your question.
You have contacted finder.com.au, a comparison and information service and not actually Medicare.
You will need to contact Department of Human Services directly about this matter.
All the best,
Zubair