Dental Cover Through Health Insurance

In this article we’re talking all about dental insurance, a type of health insurance that won’t make trips to the dentist any more bearable, but could save you money.
man brushing teeth in bathroom

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What is Dental Cover?

Dental cover is generally a form of extras cover that can be added onto your private health insurance policy. As part of your insurance plan “extras,” you might have cover for preventative dental care like cleaning, plaque removal, checkups, and small fillings.

To stay on top of your dental health, experts recommend 1 that you visit the dentist once or twice a year. Dental cover  can help pay for these routine visits, or even help cover big procedures like wisdom teeth removal.

What is usually covered?

Dental cover generally falls under two categories:

  • General dental which can include basic things like routine cleanings, fluoride treatments, x-rays, teeth bleaching, and small fillings. Some of this work is considered preventative and might be included in your extras cover.
  • Major dental, which is designed to cover more involved treatments like teeth extractions, crowns, bridge, and dentures. This cover might also cover orthodontics (braces), and endodontics (root canal surgery).

Exact coverage will depend on your health policy and provider.

Can I just get complete coverage?

Many funds offer a full cover option for preventative treatments. These plans are known as “No Gaps” insurance, and will generally cover 100% of the cost of fluoride treatment, x-rays, and routine cleaning.

Even with no gaps preventative dental coverage, you’ll still be asked to cover at least part of the cost of larger procedures like fillings, crowns, and orthodontic work. Even though these procedures will still cost you, having suitable cover could still save you money.

Can I use my plan straight away?

As part of your health insurance policy, your dental cover will likely come with a waiting period. Waiting periods are there to make sure people don’t only take out insurance policies when they need to pay for larger procedures2. Because of that, it can save you money in the long run to include dental cover in your health insurance policy before you head to the dentist for a big procedure.

How long you have to wait to use your dental cover will depend on the type of coverage you have. If you’ve gone without any general coverage, you’ll most likely wait 2-6 months on average for the preventative treatments and 12 months for the major work so it’s important to plan ahead.

What are the waiting periods for dental cover?

Waiting periods for major dental plans will vary depending on the type of treatment. The more intense a category of treatment is, the longer you’ll need to wait before you can use your dental cover in your insurance plan. The least intensive type of treatment is preventative dental work which includes preventing, diagnosing, and treating tooth diseases. Because this type of care is less intensive, it generally has a  shorter waiting time.

Finally there is endodontic work such as root canals and crowns. These types of procedures typically have the longest waiting period, in some cases up to 12 months.

Knowing the type of dental care you may want in the future can help you determine the level of care you might want. For example, someone who has already had braces may choose a plan without orthodontic care. However, it’s important to keep in mind that you can’t always plan ahead for dental emergencies.

Helpful Tip:

Although most Australians can access medical care through the public hospital system, when it comes to dental generally some concession card holders such as pensioners are eligible for free dental care under Medicare. For the rest of us, we have to pay for our own dental treatments ourselves. Taking out a private health insurance policy that includes dental under extras cover will help you cover the cost of any dental treatment you may need, and some policies even include free (no-gap) preventative treatments such as regular check-ups and cleans.

Remember, if you want to be covered for a private birth (which may also include wanting a private room and better accommodation and facilities), make sure that you are covered for a full 12 months before the baby is born.

Author Sarah McKay

Sarah McKay, Neuroscientist, author, speaker, & media personality.

What should I look for in Dental Cover?

The level of coverage you want is the first step in choosing dental coverage. But there are additional factors you might want to consider before choosing a provider.

Per person limits

Your policy will most likely come with a maximum amount that each person can claim per year. If you’re purchasing a plan for a family, you may want to make sure you understand what each person’s limit is.

Percentage Benefit versus Set Benefits

If you’ve never purchased extras cover like dental cover before, you might not be used to the way it works. While your basic private health insurance policy is there just in case something happens to you,  extras cover such as dental cover are designed to work as a budgeting tool that helps you reduce the cost of things like dental treatments.

There are two ways your health fund will cap your dental treatment discounts. Percentage benefits give you back a percentage, for example 60 per cent, of your treatment bill back to you. A set benefit plan will charge you a set amount for different treatments, regardless of what the dentist charges. Many insurers will use a combination of set and percentage benefits.

Annual limits

In addition to per person limits, your plan could have an annual limit. For example, you might have an annual limit of $1,000, which means any dental work you get above that will come out of your own pocket.

Remember, dental coverage is included in your extras cover. So be on the lookout for what other extras could come with your plan, like optical coverage.

Am I covered for dental treatments under Medicare?

Both children and adults may be eligible for dental coverage under Medicare.

Children could be able access dental coverage through Medicare under the Child Dental Benefits Schedule3. To access this benefit children must be eligible for Medicare, between two and seventeen years of age, and they or their parent must be receiving a Centrelink payment or other benefit like the Family Tax Benefit A4. This benefit is capped at $1,000 per child every two years and can cover many preventative dental treatments. Orthodontic care and other intensive treatments are not covered.

Adults with a Health Card, Pensioner Concession Card or a Commonwealth Seniors Health Card can also be covered. The level of coverage and treatments covered will vary by state. For example, public dental cover in Victoria will cover general dental care and some special services for those who are eligible.

What level of cover do I need?

Knowing what type of dental work you’re likely to need in the future can help you choose an appropriate level of cover. It’s hard to account for dental emergencies, but there are a few things you should consider before choosing a plan. How old you are, whether you’re single or have a partner, and other factors will all impact how much cover you might need as well as the plans you’re eligible for.

Whether you want to be  prepared for dental emergencies, or are just looking for a bit of coverage to cover routine cleanings, it can pay to compare plans before you commit. And our friendly health insurance team has got your covered. Start comparing Health Insurance plans using our online tool, or give us a call on 13 19 20.

Sarah McKay

Endorsed by:
Sarah McKay

Neuroscientist and author

Dr Sarah McKay is a neuroscientist, speaker, author, and media personality. She is the founder of Think Brain and the Neuroscience Academy suite of training programs, which provide professional development training in applied neuroscience and developing a healthy brain.


Last updated: 23/11/2020

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