Compare dental insurance cover

Insurers will usually outline what’s covered in their policy product summary (usually a PDF document found on their website) – you can check this document to see if a treatment is listed under a dental cover category, like general dental or major dental.

If you can’t see a treatment listed on your cover, you can check with your health fund to confirm if your policy does or doesn’t cover it.

Any silver hospital policy or gold policy has to cover dental surgery in a private hospital, think things like dental implants or wisdom teeth removal. Some bronze plus policies might also include dental surgery, but it’s optional for health insurers. For basic health insurance policies, dental could be included, too, but you might only find restricted cover for these procedures.

However, certain dentistry procedures can require you to have both hospital and extras cover if you want to claim as much as you can back. The most obvious example of this is getting your wisdom teeth removed. For instance, if you need to be admitted into a hospital for this surgery, you’ll probably also need hospital cover, even though the removal of teeth is covered under your extras policy.

If you want to avoid any surprises, have a chat with your health insurer. They’ll clarify what’s covered.

Many funds offer a full cover (‘no-gap’) option for preventative dental, covering 100% of the cost of treatments like fluoride treatment, check-ups and routine cleaning. However, you’ll usually need to visit a dentist affiliated with your health fund.

When it comes to procedures like fillings, crowns and orthodontics, full coverage is much rarer. Still, even if these procedures can come with out-of-pocket expenses, a suitable policy could help you claim back part of the cost.

Waiting periods for dental cover can range from 2 to 12 months, and vary depending on the type of treatment. Categories that cover complex treatments, like root canals or braces, are likely to have longer waiting periods than those that cover basic dental treatments, like cleans and check-ups.

However, insurers are allowed to set the waiting periods on their policies and might buck the trend. This is why it’s a good idea to compare cover, including looking at different waiting periods, before settling on an extras policy.

Sometimes health funds offer no waiting periods for preventative dental, like regular cleans and examinations. But these are the exception, not the rule. More complex (and expensive) dental treatments will likely still have waiting periods on these extras policies, too.

While you can find dental-only health insurance, it isn’t common; even the most basic extras policies tend to include more than just dental services, like optical cover and ambulance cover, too.

If you’re looking to keep your extras streamlined, you could look into flexible extras policies, which let you pick and choose a certain number of services to cover. Just keep in mind that you might still end up paying for more things than only dental coverage.

There are limits to how much you can claim on dental insurance, like $400 to $1,300 or more. All extra insurance policies come with such limits and that includes extras policies that offer dental cover.

Here’s a quick introduction to limits:

• Annual limits are the maximum your insurer will pay for specific treatments each year (this can be calendar years, financial years, or anniversary of your membership). For example, you might have an annual limit of $1,000 for orthodontics. Anything above that will come out of your own pocket.
• No annual limits sometimes apply to cheaper, more common services on comprehensive extras. For instance, an extras policy that covers lots of dental treatments might have no annual limits for routine dental. This means you can keep claiming all year long (and, hopefully, won’t need to use those more expensive treatments all that often!).
• Per person limits can apply on family and couples policies, where each person has their own cap on how much they can claim for on certain services each year.
• Lifetime limits are different to annual limits as they don’t reset every year but carry over your lifetime (and across policies and health funds). Once you hit your lifetime limit, like for orthodontics, you can’t claim for that category anymore.

Some policies increase your limits over time to encourage you to stick around. For instance, your first-year dental limit might only be $1,000, but if you stick with your policy for a few years, it might increase to $1,300. You can check the policy documents to see if a policy’s limits increase with loyalty.

Extras cover benefits (sometimes called ‘rebates’ or simply ‘money back’) are typically paid as either a percentage of your treatment bill, up to your annual limit, or as fixed amounts (set benefits) back on eligible treatments, no matter what your dental fees are. For example, this could be a set amount of $27 for fluoride treatment.

Policies might make use of both benefits across different services. You can check the policy documents to see how your benefits will be paid.

Medicare doesn’t typically cover dental treatments outside of the Child Dental Benefits Schedule (CDBS) for children or to correct certain cleft and craniofacial conditions.

To be eligible for the CDBS, children need to be 17 or younger, and they or a parent must be receiving a Centrelink payment or other benefit like the Family Tax Benefit. Through the CDBS, Medicare covers up to $1,158 per child over 2 calendar years. This includes for preventative dental services like check-ups, X-rays and cleans, and early interventions, like fillings and simple tooth extractions. Orthodontic work isn’t covered.

For adults with a Health Care Card or Pensioner Concession Card, your state or territory might cover basic dental work at a public dental clinic. Coverage and treatments will vary by state, and the waiting lists can be very long.

Extras cover can be a way to look after your dental needs and claim some money back when you aren’t eligible for these services and/or want a greater number of dental services covered.

Your current dental health can be a good guide for the level of cover you may need. If you’re teeth aren’t giving you trouble and you brush and floss regularly, you might only need general dental. However, if you’re losing sleep over an aching tooth from grinding in your sleep, major dental could be the way to go. If you have a partner or children, you might want to take their dental needs into consideration, too, in case a shared policy could be a suitable option.

Even if dental health insurance is your top priority, take a moment to think about any other extras that could be handy. Even a lower level of extras can include more than just dental cover. For instance, you might be interested in physiotherapy, chiropractic or podiatry, too.

Considering your budget and how much you’d like to get back on eligible dental services can also help you narrow down your cover options. Often, cheaper extras policies have lower annual limits. This could balance out for you, or you might prefer to get more back (particularly if you’re looking at having a lot of dental work done).