Not sure what you can claim on Medicare? Find out which dental services are covered.
Dental treatments are normally only covered by Medicare if they are considered essential for the wellbeing of the patient. While some dental procedures are covered, most general dental examinations and treatments are not, and only certain eligible children and adults can access dental treatment subsidised by the government. This guide looks at who is eligible, the procedures that are and aren’t covered and the level of public dental health care offered by the various states and territories.
How does Medicare cover dental procedures?
While 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:
- 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. To be introduced early in 2017, this scheme will provide ongoing joint funding with the states and territories to assist them with providing public dental services for adults with concession cards and for all children.
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.
Which dental procedures can be covered by Medicare?
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 (eg, 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.
Which dental procedures can be covered by Private Health Insurance?
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 (LHDs). Services include general dentistry (eg, 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.
- Eligibility
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.
- Fees
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.
- Clinics
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.
- Eligibility
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.
- Fees
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.
- Clinics
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.
- Eligibility
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 their 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.
- Fees
Public sector oral health services are funded by the Queensland Government and are provided at no charge to eligible patients.
- Clinics
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.
- Eligibility
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.
- Fees
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
- Clinics
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.
- Eligibility
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.
- Fees
Dental services are provided free to eligible adults and children, although waiting lists may apply and patients are prioritised according to urgency.
- Clinics
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.
- Eligibility
Adults must hold a Health Care Card or a Pensioner Concession Card and all children under 18 years of age are eligible, including pre-schoolers.
- 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.
- Fees
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.
- Clinics
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.
- Eligibility
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
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.
- Clinics
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.
- Eligibility
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.
- Fees
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.
- Clinics
You can find a full list of dental clinics in SA by location for both children and adults at the SA Health website.
Compare dental insurance options offered by over 30 health funds
Use the comparison engine to filter by dental service
Tired of trawling through multiple policies trying to work out which type of dental treatment is covered? Simply enter your details on the form above, hit Search Policies and use the blue filter button in the top right-hand corner to sort policies by general dental, major dental, endodontic and orthodontic.
Picture: Shutterstock
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