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Health Insurance for Major Dental Procedures
Health Insurance for Major Dental Procedures
Written by
Tina Sendin
Edited by
Ellie Garran
Reviewed by
Andres GutierrezCompare Health Insurance Policies
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What is major dental?
Long story short
An extras policy with major dental cover takes care of complex treatments like crowns and dentures
This is different from general dental, which covers routine check-ups, cleans, and small fillings.
Health insurance can help, but you could face a waiting period
There’s usually a waiting period of 12 months before you’re covered for major dental procedures, so it pays to get insured before you need it.
Major dental procedures can cost thousands out of pocket
Without health insurance, a root canal can cost around $4,000 or more, while veneers can start at around $1,000.
What is major dental?
Major dental procedures
Major dental procedures are a step up from your standard check-up and clean. They’re more complex and invasive, and often involve restoring or replacing teeth or dealing with more serious dental issues.
Common examples of major dental procedures include:
- Crowns and bridges: These are used to cover a damaged tooth or fill a gap where a tooth is missing.
- Root canal therapy: This treatment saves a tooth that is badly decayed or infected.
- Wisdom teeth removal: This treatment isn’t always complex, but when it is, it can involve surgical extractions that need to be done by an oral surgeon.
- Dentures: These can be full or partial sets to replace missing teeth.
- Dental implants: This is a surgical procedure to replace a tooth root with a metal post.
Major dental cover
Major dental cover is the subcategory of health insurance that covers major dental procedures. It’s generally available in higher levels of extras cover. This type of insurance is more expensive (because the treatments often involve surgery) and involves longer waiting periods, typically 12 months. The treatments that it includes can vary between policies. Some treatments, like root canal therapy, are sometimes found in ‘major dental’ and sometimes in different categories.
Other types of dental cover
Endodontics and periodontics
You can think of endodontics as treatments and surgery of the soft tissue, like root canal therapy. Meanwhile, periodontics is all about non-tooth-related surgery – like to your gums or jaw.
You might want to double-check your policy, as some health funds include these treatments under major dental, some include periodontics under general dental, and others have them as separate categories.
Orthodontics
This type of dental cover takes care of orthodontic treatments to fix jaw irregularities and straighten teeth through braces, bands, or Invisalign. Orthodontics is often its own separate category, even if putting braces on sounds pretty major.
It’s often included in comprehensive (and more expensive) extras policies. The waiting period is also generally 12 months.
Basic dental
Also sometimes referred to as routine or general dental, this type of dental cover is what it sounds like – basic. Think about your routine dental check-ups, cleanings, fluoride treatments, and small fillings.
This is typically available in basic extras policies. The waiting periods are usually short, around two months.
How much do major dental procedures cost?
The cost of major dental procedures can vary wildly depending on the treatment, your dentist, and where you live in Australia. Here’s what generally makes up the final bill:
- dentists’ and specialists’ fees: what your dentist or oral surgeon charges for their expertise
- hospital fees: if your procedure requires a hospital stay, this covers your bed, theatre use, and other related charges
- consultation fees: the initial appointments to assess and plan your treatment
- diagnostics: costs for X-rays, scans, and other tests needed to get the full picture.
The cost of major dental work can really take a bite out of your budget. The public system doesn’t typically cover major dental procedures, and going private can cost you thousands.
Without private health insurance, you’re looking at paying the full amount out of your own pocket. The total cost of major dental procedures in the private system can range from a few hundred dollars for simpler treatments, to thousands (if not tens of thousands) for more complex work like crowns, bridges, or implants.
- A root canal can set you back anywhere from around $4,000 to $7,000.
- An upper denture could cost around $2,000.
- A porcelain veneer could set you back between around $1,000 and $3,000.
- Don’t even get us started on things like all-on-4 implants, as regular patients without dental cover could end up paying somewhere between $24,000 and $35,000!
Private health insurance with dental cover can help take the sting out of these costs.
Helpful tip
Keep in mind that annual limits apply to health cover. They’re the maximum amount you can claim for major dental services per year.
If a couple of major dental works are on the cards, have a chat with your dentist about how you can spread treatments across a few years to make the most of your cover. For example, you can plan an implant this year and a crown next year to maximise your annual limits.
Your needs can change over time (maybe both you and the kids are needing a bit more dental TLC lately), so it makes sense to give your policy a yearly check-up. You might want to consider comparing policies and looking at things like annual limits for major dental and the percentage benefit you get back per service.
Andres Gutierrez
General Manager – Health
Are there other out-of-pocket costs for major dental procedures?
Even with a private health insurance policy, you’ll likely have some out-of-pocket expenses. So it’s important to be prepared for more than just the dentist’s bill. Depending on your procedure, you might also face costs for:
This is where having the right combination of hospital and extras cover could be a real lifesaver.
Are there other costs after major dental procedures?
The costs don’t always stop when you leave the dentist’s chair. You might need:
- prescription medication: painkillers or antibiotics to manage discomfort and prevent infection
- follow-up appointments: to check on your healing and remove stitches
- maintenance: some treatments, like implants or bridges, may require maintenance or replacement down the track.
It’s worth asking your dentist the expected costs, both during and after the procedure.
How long will I have to wait for major dental procedures?
Let’s look at the wait from two angles: dentists’ waiting lists and your health fund’s waiting period.
Is there a waiting list involved for major dental procedures?
The good news is that most Australian dental services (yes, including major procedures) are done in the private system. This means you probably won’t be stuck waiting around on a public list for what could feel like forever (especially with a terrible toothache).
Do I need to serve a waiting period with my health fund?
Thinking about getting private health insurance and claiming for major dental right away? Not so fast! Most health funds have waiting periods you’ll need to complete before you can access those benefits. This prevents people from signing up, claiming for a major procedure, and then cancelling their policy straight away. It makes total sense, really.
Private health funds have mandated waiting periods for hospital cover – 12 months for pre-existing conditions and two months for other cases.
But for extras cover (like dental), it can vary between insurers. For major dental, the standard waiting period is usually 12 months. For general dental, it’s typically two months.
We’re talking about both hospital and extras cover because some complex dental issues may need to be done in the hospital. Having both hospital and extras cover can help make things a little less painful – both for your pearly whites and your wallet.
For instance, if you need to go through a complicated wisdom tooth surgery in the hospital, guess what could help cover the cost of your hospital bed and theatre – yep, having the right level of hospital cover. And if you have dental cover as part of your extras policy, then it could help you pay the dental fees.
What level of health insurance do I need to cover major dental procedures?
Private health insurance can be a gamechanger when it comes to shelling out for major dental procedures. Dental treatment is generally covered under your extras benefits (which can include different levels of dental cover). If you need a procedure done in hospital, hospital cover can help with those fees.
Extras cover with major dental
An extras policy that includes major dental will help pay the specialist’s fees for procedures like crowns, bridges, and root canals. This is often found in a higher level of cover than a basic extras policy.
Silver or gold hospital cover
If your procedure is complex enough to require admission to a hospital (for example, surgical removal of impacted wisdom teeth), hospital cover comes into play. Dental surgery is typically included in silver and gold tiers of cover, and potentially in bronze plus policies. This helps with the costs of accommodation and theatre fees, while your extras cover helps with the dentist’s or surgeon’s bill.
Frequently asked questions
Are major dental procedures covered by Medicare?
Generally, no. Medicare doesn’t cover most dental treatments for adults. Public dental services exist, but they often have long waiting lists and strict eligibility criteria. For many people, private health insurance is the primary way to get help with the costs of major dental work.
Does major dental cover include wisdom teeth removal?
Yes, but it depends on the type of wisdom teeth extraction. A simple extraction might be covered under general dental. However, surgical removal of impacted wisdom teeth is firmly in the major dental category. If it’s done in a hospital, you’ll need both extras and hospital cover to be properly covered.
Can I get dental cover with no waiting period?
Sometimes. Health funds occasionally run promotional offers where they waive the two-month waiting periods for general dental. However, it’s rare for them to waive the 12-month waiting period for major dental.
Is major dental cover worth it?
You can look at it this way. If you have good dental health and only need routine check-ups, a basic extras policy might be enough. But if you anticipate needing major work like crowns or implants, or you have troublesome wisdom teeth, a policy with major dental cover could save you thousands of dollars in the long run.
The key is to weigh the cost of the premium against the potential out-of-pocket expenses.
How do I choose the right insurance plan that includes major dental?
You can make smart choices for your dental care by comparing private health insurance options. Toothfully speaking, we’ve got you and your dental cover.
Check out our comparison tool to find health a range of insurance policies. You can also call 1800 784 772 and speak to our health comparison experts. They can handle the major heavy lifting and help you find dental cover options for your pearly whites.
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