Does Medicare cover dental?
It’s no secret that keeping our teeth healthy can be expensive, with upwards of $11 billion being spent on dental services in Australia every year, according to the Australian Institute of Health and Welfare.
Key points:
- Eligibility for public dental services is based on a number of factors that vary across different states and territories
- Children can be covered through the Child Dental Benefits Schedule or certain school programs
- Adults may be covered if they have a Health Care Card, a Pensioner Concession Card or a Commonwealth Seniors Health Card
While the post-visit bill can at times seem almost as painful as the toothache you came in for, there are some scenarios where your bill – or at least part of it – could be covered by Medicare, depending on your situation and the type of treatment you receive.
Eligibility for public dental services is based on a number of factors that can vary across different states and territories. Here’s a summary of what may be covered:
Who is eligible for dental services through Medicare?
Medicare offers rebates for both children and adults to access dental care in certain scenarios.
Children can be covered through the Child Dental Benefits Schedule (CDBS). To be eligible, children must be between 0 and 17 years old, be eligible for Medicare and they or a parent must receive an eligible Centrelink payment (such as the Family Tax Benefit A) at least once that calendar year.
The benefits are capped at $1,052 per child every two calendar years and cover services such as:
- Check-ups
- X-rays
- Cleaning
- Fissure sealing
- Fillings
- Root canals
- Extractions
The CDBS does not cover orthodontic, cosmetic or in-hospital dental treatment.
Adults can also be covered if they have a Health Care Card, a Pensioner Concession Card from the Department of Human Services (DHS) or the Department of Veterans’ Affairs (DVA), or a Commonwealth Seniors Health Card from the DHS or DVA. Eligibility and treatment options can vary depending on the state or territory you live in.
We’ve listed some key details, eligibility requirements and potential out-of-pocket costs of the various dental services available under the public system, as well as where you may be able to access these services in each state and territory.
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Public dental services in Australian Capital Territory
Services covered
Public dental services in the ACT are available for general dental care as well as some emergency services.
Public dental services for children includes:
- Check ups
- X-rays
- Fillings
- Teeth cleaning
- Preventative treatment such as fluoride
- Tooth extractions
Public dental services for adults includes:
- Check ups
- X-rays
- Fillings
- Teeth cleaning
- Preventative treatment such as fluoride
- Tooth extractions
- Root canal on eligible teeth
- Wisdom teeth extraction
- Dentures
Public dental services are managed through a waiting list system. Estimated waiting times vary depending on the treatment required.
Fees
At the time of writing, ACT Health does charge fees for certain services, depending on your circumstances. There is no fee for children under five years old.
- A standard fee of $72.60 applies for children aged over five years per course of care, unless they are eligible for free services.
- For adults, co-payments may apply: an emergency course of care is $47.35.
Costs are capped at $450 for adults for restorative treatment in any calendar year.
Eligibility
- All children aged 0-14 who live or attend school in the ACT.
- Young people under the age of 18 with a Centrelink-issued Pension Concession or Health Care Card.
- Adult dental services are available to ACT residents who are the primary holder of a Centrelink-issued Pension Concession or Health Care Card, a Veteran’s affairs card or an ACT Services Access card
Where can I access public dental services in the ACT?
There are a number of public dental service clinics available in the ACT, located in Belconnen, Canberra City, Gungahlin, Phillip and Tuggeranong. You can find your local clinic on the ACT Health website.
Public dental services in New South Wales
Services covered
NSW Health provides “safety net” dental services for eligible NSW residents. Public dental clinics are usually located in public hospitals and community health centres.
Patients are prioritised for care through a triage system. This means that patients with urgent dental conditions are treated sooner, and there may be wait times for routine dental care.
Eligibility
- All children under 18 years of age who are NSW residents.
- Children may also be eligible for the Primary School Mobile Dental Program which is offered across five local health districts.
- Adults who are NSW residents, eligible for Medicare and have a Health Care Card, Pensioner Concession Card or Commonwealth Seniors Health Card.
Where can I access public dental services in New South Wales?
Public dental services are available in each of the local health districts across NSW and are based in community health centres, hospitals and schools.
In regional areas, clinics may be located within hospitals, schools, community health facilities or in mobile dental clinics. You can find your local clinic on the NSW Health website.
Public dental services in Northern Territory
Services covered
Routine and emergency dental services are covered through the public system in the NT for eligible people. These include:
- Check-ups
- Pain and trauma management
- Emergency care
- Restorative fillings and repairs
- Endodontics
- Extractions
- Oral hygiene
- Oral health promotion
- Denture services
Specialist services are also available and include:
- Orthodontics
- Oral surgery
- Dental treatment in hospital
- Special needs dentistry
Demand for adult dental services is high, so there may be a waiting list. Urgent problems will have priority.
Eligibility
- Children up to 18 years who are attending school are eligible. But children who have been living in the NT for less than six months are not eligible for general services, but can still access emergency dental services.
- Adults with a Centrelink Pensioner Concession Card or a Centrelink Health Care Card.
- Those who are part of the Federal Government’s cleft lip and cleft palate scheme are eligible.
- Remote residents living more than 100km from a health service and requiring emergency dental care without access to private dental services.
Where can I access public dental services in the Northern Territory?
Child dental services are usually offered by dental therapists and oral health therapists through school-based clinics, community clinics, remote health centres and mobile services.
Adult dental services are available in community dental clinics, listed on the NT Government’s website.
Public dental services in Queensland
Services covered
Public dental services in Queensland can cover both general and emergency dental services. Available treatments can include:
- Diagnostic services, including dental x-rays and check-ups
- Preventative and early intervention services, such as dietary advice and oral hygiene education
- Fillings
- Tooth removal and minor oral surgery
- Making new or repairing existing dentures
- Root canal treatment for front teeth
- Management of simple orthodontic issues
- Emergency palliative care
Specialist services may also be available, but this is dependent on the local health service.
Public dental services are managed through a waiting list system. Estimated waiting times vary depending on the treatment required.
Eligibility
The Queensland Government advises that you must be eligible for Medicare in order to be eligible for dental care in the state’s public health system. There are a couple of additional criteria that vary depending on whether you’re a child or an adult.
Specifically, for a child to be eligible, they must also:
- Be either a Queensland resident and/or attending a Queensland school, and meet at least one of the following criteria:
- Be aged four years or older and have not completed Year 10, be eligible for the Medicare Child Dental Benefits Schedule hold, or be listed as a dependent on, a valid Centrelink concession card
Public dental care for children may be provided on-site at schools through fixed or mobile dental clinics or at larger community dental clinics by teams including dentists, oral health therapists, dental therapists and dental assistants.
Adults, on the other hand, must generally:
- Be a Queensland resident
- Receive benefits from either a Health Care Card, a Pensioner Concession Card, a Commonwealth Seniors Health Card or a Queensland Seniors card.
Where can I access public dental services in Queensland?
At the time of writing there are 15 local area health services across Queensland – including Cairns and Hinterland, Brisbane metro areas, Sunshine Coast, Central Queensland and the Gold Coast – where local dental clinics or mobile vans provide public dental services. You can find your local clinic on the Qld Health website.
Public dental services in South Australia
Services covered
General and emergency dental care is available through the public system in SA.
Services for children and adults may include:
- Check-ups
- Cleaning
- Preventive treatment to keep teeth and gums healthy
- Fillings
- Tooth removal
- Root canal treatment
Some specialist services are provided by referral at the Adelaide Dental Hospital (ADH).
Specialist services may include:
- Tooth removal (extraction)
- Surgical procedures of the mouth and jaws (oral and maxillofacial surgery)
- Banding (orthodontics)
- Diseases of the gums (periodontics)
- Special needs dentistry for medically, physically and intellectually disabled patients
There are waiting lists for almost all adult dental services, with wait times depending on the clinic and type of dental care needed. There are no waiting list for children.
Fees
Dental care is free for most children under 18 (bulk billed to Medicare), however a “small fee” may apply for children not covered by the CDBS, according to SA Health.
Adults contribute towards the cost of their dental care with fees differing for general and emergency dental care. At the time of writing, this fee was $65 for emergency services and up to $166 for general services.
Eligibility
- All babies, children and young people under 18 years who either live in or go to school in South Australia can access dental care at SA Dental clinics.
- Adults who have a current Health Care Card or Pensioner Concession Card and live in South Australia. Dependents of the card holder who are under 19 years of age may also be eligible.
Where can I access public dental services in South Australia?
Dental services are available at clinics throughout South Australia. You can find your local clinic on the SA Health website.
Public dental services in Tasmania
Services covered
Public dental services are available in Tasmania for general dental as well as some emergency services.
All children under 18 can access public dental services, which are usually conducted by dental and oral health therapists. Services include:
- Check-ups
- Any necessary treatment as determined following the check-up
- Preventative treatment
- Dietary advice
- Oral hygiene instruction
- Referrals to see a dentist for further assessment or treatment, if required
Adult dental services under the public system cover general dental care. This includes:
- Check-ups
- Scale and clean
- Fillings
There are waiting lists for non-urgent and general dental care. Those deemed to have an urgent dental problem will be offered an appointment based on the individual circumstance and only the urgent problem will be addressed in the appointment.
Fees
At the time of writing, all adults are required to pay a co-payment of $45 towards their dental care.
Eligibility
- All children under 18 years of age
- Adults who hold a current Pensioner Concession Card or Health Care Card
Where can I access public dental services in Tasmania?
Dental services for adults are available via six major dental centres in Tasmania, located in Burnie, Devonport, Launceston, Clarence, Glenorchy and Hobart. Find your local clinic.
Dental and oral health services for children are available across Tasmania. You can fill out an appointment form or call 1300 011 013.
Public dental services in Victoria
Services covered
Public dental services in Victoria cover general dental care as well as some special services. General dental care includes:
- Routine dental examination
- Check-ups
- Oral health advice
- Scale and cleaning
- Extractions
- Fillings
- X-rays
- Fissure Sealants
- Root canal treatments
The Victorian Government offers free dental services to school students through their free school dental program Smile Squad and includes all required treatment (excluding orthodontics).
Smile Squad offers the following services to all Victorian government school students:
- Free oral health promotion
- Free annual dental health check-ups
- Free follow-up treatment as needed
Public dental services, aside from emergency care, are managed through a waiting list system. Estimated waiting times vary depending on the treatment required.
Fees
Providers of public dental care in Victoria may charge fees.
- Treatment is free for children and young people aged 0-17 years who hold a health care or pensioner concession card, or who are dependants of concession card holders
- Children aged 12 and under whose parents do not hold a concession card pay $36 per course of care (up to a maximum of $144 per family).
- Adult services carry a charge of $30.50 per visit, with the cost of one complete general course of care not exceeding $122.
- Emergency treatment is free for eligible children and $30.50 for adult Health Care and Pensioner Concession cardholders.
Eligibility
Some people may be eligible for either free or subsidised public dental services in Victoria including but not limited to:
- All children aged 0 to 12 years.
- Adults and adolescents aged 13 years and over are eligible if they hold a Health Care Card or Pensioner Concession Card, or if they are a dependent of someone who does
- People aged 18 years and over, who are health care or pensioner concession card holders or dependants of concession card holders
- All Aboriginal and Torres Strait Islander people
Where can I access public dental services in Victoria?
Public dental services are available through The Royal Dental Hospital Melbourne and 79 clinics across Victoria. You can find your local clinic on the Dental Health Services Victoria website.
Public dental services in Western Australia
Services covered
Public dental services in WA are available for general dental as well as some specialist services through Dental Health Services (DHS).
- The School Dental Service provides free general dental care to eligible school children. This includes:
- Routine dental examinations
- Oral health advice
- Extractions
- Fillings
- X-rays
- Fissure sealants
- The General Dental Service provides services for eligible adults including:
- Routine dental examinations
- Oral health advice
- Scale and cleaning
- Extractions
- Fillings
- X-rays
- Fissure sealants
- Root canal treatments
Specialist dental services such as oral surgery and orthodontics are not provided at dental clinics and patients will be referred.
There is a waiting list for non-urgent dental services. Public dental services are managed through a waiting list system. Estimated waiting times vary depending on the treatment required.
Fees
At the time of writing, DHS does charge fees for certain services, depending on your circumstances.
Fees apply to adult services, with a maximum of 75% of the cost subsidised by the WA Government. The level of subsidy you receive is based on the income you receive from Centrelink.
Eligibility
- Most children aged five to 16 attending school in WA are eligible for free dental care under the School Dental Service.
- People aged 17 and over with a Western Australian Health Care or Pensioner Concession Card, or who have a dependent child below four years old are eligible.
- For emergency treatment, the same eligibility applies as above.
Where can I access public dental services in Western Australia?
Public dental clinics are located throughout Western Australia. You can find your local clinic on the WA Health website.
What dental services are covered by private health?
Dental services may be covered through either hospital or extras health insurance policies. Most extras policies subsidise general dental (including regular check-ups, scale and cleans and most preventative services).
But major dental work (such as crowns, bridges, surgical extractions, wisdom teeth, dentures and root canal therapy) and orthodontics (braces, retainers, fittings, and similar procedures) generally require a higher level of extras cover.
Before commencing with any dental treatment, it can be a good idea to contact your private health insurer to find out what dental services are covered as part of your insurance policy.
You can also confirm if you have any limits in the amount you can claim and if there is any waiting period for your specific treatment.
Some private health policies will allow you to see specific dentists (as determined by them) for a reduced or waived gap. But it’s a good idea to not only research the details of your policy carefully but ensure you’re happy with their choice of dentist.
It’s also important to note that any dental surgeries that need to be done in hospital will require private hospital cover if you aren’t eligible for or would prefer not to use the public system. The types of surgeries requiring this type of cover could include wisdom tooth removal and dental implants.
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Ann Lund updating an article originally by Ali Hiddlestone
Cover image source: LightField Studios/Shutterstock.com
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This article was reviewed by our Content Lead Ellie McLachlan before it was updated, as part of our fact-checking process.
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