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Uncovering the tooth: Does Medicare cover dental?

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It’s no secret that keeping our teeth healthy can be expensive, with Australians spending upwards of $10 billion on their dental services every year, according to the Australian Institute of Health and Welfare.

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 two 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. The benefits are capped at $1,000 per child every two calendar years and cover services such as examinations, x-rays, cleaning, fissure sealing, fillings, root canals and 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. 

Here we have 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.

Public dental services in New South Wales

Services covered

Public dental services in NSW cover both emergency and general dental treatment, with urgent conditions given a priority code from one to six. Priority one services (which is the highest priority) include:

  • Dental trauma or injury
  • Swelling of the face or neck
  • Swelling in the mouth
  • Bleeding from the mouth that won’t stop 
  • Difficulty opening jaw and/or swallowing. 

Most dental services that you may receive at a check-up are listed under priority five, including:

  • Extractions
  • Fillings
  • Crown and bridge
  • Scale and clean
  • Broken or chipped tooth
  • Ulcers 

To give you an idea of how long you may need to wait to see a dentist in NSW, the recommended maximum waiting times for priority one symptoms is 24 hours, whereas for priority five, it is 12 months.  A general check up with no symptoms is a priority six, and currently has a recommended maximum waiting time of two years.  

All public dental services are managed through a waiting list system. Further details on symptoms and the associated wait times can be found on the NSW Health website. 

Eligibility

  • All children under 18 years of age who are NSW residents. 
  • Children may also be eligible for the Mobile Dental Program depending on the primary school they attend. 
  • 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 Victoria

Services covered

Public dental services in Victoria cover general dental care as well as some special services.

  • General dental services for eligible children include:
    • Check-ups and advice every one to two years
    • Dental sealants to prevent decay
    • Cleaning
    • Fillings
    • Extractions
  • General dental services for adults include:
    • Examination
    • Cleanings
    • Fillings
    • Extractions
    • Root canal treatment
  • Specialist services are also available and include:
    • Orthodontics
    • Oral and maxillofacial surgery
    • Endodontics
    • Periodontics
    • Prosthodontics
    • Paediatric dentistry
    • Oral medicine

Fees for these services vary depending on the specific treatment, up to a maximum of $344 at the time of writing. 

Public dental services, aside from emergency care, are managed through a waiting list system. Estimated waiting times vary depending on the treatment required.

Fees

At the time of writing, Vic Health does charge fees for certain services, depending on your circumstances.

  • Treatment is free for children and adolescents if they or their parents hold a current health care or pensioner card.
  • Children aged 12 and under whose parents do not hold a concession card pay $33.50 per course of care (up to a maximum of $132 per family). 
  • Adult services carry a charge of $28.50 per visit, with the cost of one complete general course of care not exceeding $114 at the time of writing. Treatment for Aboriginal or Torres Strait Islander peoples is free at The Royal Dental Hospital of Melbourne.
  • Emergency treatment is free for eligible children and $28.50 for adult Health Care and Pensioner Concession cardholders. For everyone else, the total cost is based on the care provided.

Eligibility

The following groups of people may be eligible for either free or subsidised public dental services in Victoria:

  • 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
  • All children and young people in out-of-home care provided by the Children Youth and Families Division of the Department of Human Services
  • People in youth justice custodial care aged up to 18 years 
  • All refugees and asylum seekers
  • All Aboriginal and Torres Strait Islander peoples (when treated at The Royal Dental Hospital of Melbourne). 

Where can I access public dental services in Victoria?

Public dental services are available through The Royal Dental Hospital Melbourne and over 80 clinics across Victoria. You can find your local clinic on the VIC Health 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. For example, the target maximum waiting time for general care is around two years, and priority care is determined at an assessment where patients are placed into category one, two or three, which determines their “desirable” wait time, ranging from within one month to 12 months. These are not set timeframes, but are targets for the service, meaning your waiting time could be shorter or longer than this.

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
  • either be eligible for the CDBS, hold or be listed as a dependent on a valid Centrelink concession card, and/or be at least four years old and not yet completed year 10.

Adults, on the other hand, must generally:

  • be a Queensland resident; and
  • receive benefits from either a Health Care Card, a Pensioner Concession Card, a Commonwealth Seniors Healthcare 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 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 (applied to teeth to prevent tooth decay)
  • Services provided to adults at local public dental clinics include:
    • Routine dental examinations
    • Oral health advice
    • Scale and cleaning
    • Extractions
    • Fillings
    • X-rays
    • Fissure sealants ((applied to teeth to prevent tooth decay)
    • 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, with the addition of a child below four years old. 

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. 

Public dental services in South Australia

Services covered

General and emergency dental care is available through the public system in SA. Specialist dental treatment is also available but is limited, and a referral is needed from a community dental clinic. It includes: 

  • Orthodontics
  • Specialist restorative care 
  • Oral surgery 

There are waiting lists for almost all adult dental services, with wait times depending on the clinic and type of dental care needed.

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 $61 for emergency services and up to $157 for general services.

Eligibility

  • All children under the age of 18 are eligible via the School Dental Service.
  • 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 therapists 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
  • Dentures 

There are waiting lists for non-urgent and general dental care. Public dental services are managed through a waiting list system and there are waiting lists for non-urgent and general dental care. Estimated waiting times vary depending on the treatment required. 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. 

Children’s services are offered in urban and rural areas across the state. Call 1300 011 013 to book into the clinic nearest you.

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;
      • Comprehensive assessment
      • Individual oral health plans
      • General preventative, restorative and emergency treatment
  • Public dental services for adults includes;
    • General restorative
    • Denture
    • Emergency 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, ACT Health does charge fees for certain services, depending on your circumstances.

  • A standard fee of $67.75 applies for children aged over five years per course of care, unless they are eligible for free services.
  • For adults, costs are capped at $300 for restorative treatment in any calendar year. 

Eligibility

  • All children aged 0-14 who live or attend school in the ACT.
  • Those aged 14-18 with a current Centrelink Concession card may be able to access free services.
  • Adults over the age of 18 who hold a current Centrelink issued Pension Concession or Health Care card.

Where can I access public dental services in the ACT?

There are a number of public dental service clinics available in the ACT, with clinics located in Belconnen, Canberra City, Gungahlin, Phillip and Tuggeranong. You can find your local clinic on the ACT 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. However, 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 eight community clinics, at the time of writing. Find your local clinic. 

What 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). However, 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. However, it is 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 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.

Header Image source: Blue Planet Studio (Shutterstock)

Ali HiddlestoneAbout Ali Hiddlestone

Ali is a freelance writer covering everything from finance, health, lifestyle, travel, media and real estate. Her articles have featured in several publications including Coast Beat magazine and Huffington Post. Prior to working freelance, Ali worked extensively in TV and print media, marketing, PR and Advertising in Australia and overseas.

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