<div class="blog_content-intro"><p>Many Australians are confused about whether Medicare covers dental treatments, so we’ve created this simple guide to clear things up.</p></div>
Spoiler alert…it generally doesn’t, and this creates a real gap in our healthcare system, with many people putting off dental treatments because they're worried about costs.
Did you know?
- Australians spent around $11bn in 2021-22 on dental services
- About half of all Australians over 15 didn’t visit a dentist in 2022-23
- 3 in 10 people delay or avoid seeing a dentist because of the cost
SOURCE: Australian Institute of Health and Welfare
Understanding what Medicare covers and where the gaps are can help you make smarter decisions about your dental care. Let's get you up to speed.
Why doesn’t Medicare cover dental?
Medicare was designed to help Australians access essential healthcare, but dental care was largely left out from the start. It was a deliberate decision at the time and is still a hot topic of political debate decades later.
When Medicare (originally called Medibank) was established in 1974, the Whitlam Government initially planned to include dental care. However, due to budget constraints, dental coverage was removed before the program launched. This decision set up Australia's current dental care system, where most services remain outside Medicare.
What dental services aren’t covered by Medicare?
As a rule of thumb, Medicare doesn't cover most dental procedures, including regular checkups, cleans, fillings, tooth extractions, dentures, implants, orthodontics, crowns, bridges or root canals.
This means most Australians need to pay for dental care themselves or have private insurance.
When does Medicare cover dental care?
While Medicare doesn't typically cover dental care, there are a few specific exceptions.
If you’re under 18 and eligible for the CDBS
Medicare provides dental coverage for eligible children aged 2-17 through the Child Dental Benefits Schedule (CDBS). This program offers benefits for basic dental services up to a capped amount over two consecutive calendar years.
To qualify for CDBS, families must receive other government benefits like Family Tax Benefit Part A. The program isn't universal – it's designed to help families who might otherwise struggle to afford dental care for their children. It doesn't cover orthodontic treatment (like braces), cosmetic dental work or any dental services provided in a hospital.
If it’s part of another treatment
Medicare may cover your dental treatment if it's essential for another Medicare-approved surgery. For example, if you take a tumble when mountain-biking and break your jaw, Medicare will likely cover any necessary tooth extractions before doctors can repair your jaw. However, follow-up or ongoing dental treatments after this initial care usually aren't covered.
If you’re treated in a hospital emergency department
If you're treated as a public patient in a public hospital emergency room for urgent dental issues, Medicare will cover your immediate treatment. Examples include severe mouth pain or facial trauma requiring urgent pain relief.
Keep in mind this coverage is limited to emergency hospital treatment only—not follow-up care provided by dentists outside hospitals.
If you’re eligible for public dental services
Each state and territory offers public dental services for eligible adults and children who hold concession cards (like a Health Care Card or Pensioner Concession Card). These services can help with emergency or specialist care, but waiting times can be lengthy. To find out if you're eligible and what's available near you, visit your state or territory health department website directly.
Common gaps in Medicare's dental coverage
Because Medicare offers limited coverage, many Australians face significant gaps when it comes to everyday oral healthcare.
Routine and preventive dental care
Routine dental care like checkups, cleans and fillings isn't covered by Medicare for most Australians. Without regular preventive visits, small problems can become bigger and more expensive down the track.
Major dental procedures
Complex procedures like root canals, crowns, bridges, implants or orthodontics aren't covered either. These treatments often involve significant out-of-pocket expenses unless covered by private insurance.
Dental injuries and emergencies
While emergency care in a public hospital may be covered by Medicare, many dental emergencies are treated in dental practices rather than hospitals. These might include:
- Tooth fractures that expose the nerve
- Trauma or swelling to the face, especially if it’s hard to breathe
- An ulcer that won’t heal
- Knocked-out teeth
- Severe mouth pain
These emergencies can result in substantial costs.
To better understand potential costs for various treatments across Australia, you can use the government's medical costs finder tool.
How can you manage your dental costs?
Since Medicare's dental coverage is limited, many Australians look for other ways to manage their dental care costs.
Private health insurance with extras cover
The most common way Australians cover dental expenses is through private health insurance extras policies. In fact:
- Around 12% of adults said their insurance fully covered their last dental visit.
- In 2022-23, private insurers subsidised 50 million dental services in Australia.
Private health insurance extras policies typically include:
- Basic dental coverage (checkups, cleans, simple fillings)
- Major dental coverage (for more complex procedures)
- Annual benefit limits that reset each year
When looking at extras policies, consider:
- Level of coverage (basic vs comprehensive)
- Waiting periods (usually between 2–12 months)
- Annual benefit limits
- Percentage of costs covered per treatment
Payment plans and financing options
Some dentists offer payment plans that let you spread larger expenses over time. While these plans don't reduce your overall cost, they can make payments more manageable.
Prevention: the most cost-effective approach
The best way to keep your costs down is prevention:
- Brush twice daily with fluoride toothpaste.
- Floss daily.
- Schedule regular checkups to catch issues early.
- Address minor problems promptly before they escalate into major ones.
As Dr. Dominic Aouad, President of the Australian Dental Association NSW Branch explains: "Prevention is always better (and cheaper) than cure. Regular checkups allow early detection of problems before they become major issues. A professional clean removes hardened plaque that brushing alone can't tackle."
Making smart choices about your dental care
Knowing what Medicare covers (and what it doesn't) is essential for managing both your oral health and finances effectively. For most Australians, combining different strategies is best:
- Use any eligible public programs.
- Consider private health insurance with suitable extras cover.
- Maintain excellent preventive oral health habits.
- Budget proactively for regular checkups as part of your overall healthcare planning.
With oral health closely linked to general wellbeing, finding practical ways to access affordable regular care is something we all need to prioritise. We hope our guide helps you take action today and reap long-term rewards.
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