Dental Health Insurance In Australia - Everything You Need To Know

Dental Health Insurance In Australia - Everything You Need To Know

Hands up who hates going to the dentist? We’re taught to brush our teeth since we’re kids, but are we really looking after our mouth and teeth enough to give us that ‘we’re happy to see the dentist’ vibe? It can be expensive to both maintain or fix any issues with our teeth. Delaying visiting the dentist can lead to bigger problems down the track, and unfortunately many people delay visits due to costs.

Dentists around Australia are happy that Billy Explores is here to help you review dental health insurance, and make sure you get the right health insurance cover for any dental treatment you may need now and in the future. What things do you need to know about dental health insurance in Australia and for comparing private health insurance in Australia? Read on (and make sure you brush your teeth tonight!)

Do I Really Need Dental Health Insurance?

Many people think they’re doing the best by their teeth, but you’re probably not. The best way (apart from flossing and brushing twice a day) is to have a regular examination by your dentist.

Don’t believe it? According to figures from the AIHW, Australian adults have on average, 11.2 decayed, missing and filled teeth and there are about 72,000 annual hospitalisations for dental conditions may have been prevented with earlier treatment.

That’s a BIG ouch from Billy (yes, I go to the dentist every 6 months – but obviously I find comparing private health insurance in Australia very easy, so I can get the best dental health insurance and extras health insurance for my needs).

What Is Dental Health Insurance?

Dental health insurance is normally covered under extras health insurance, which is part of your private health insurance (hospital and extras). Dental is normally split between general dental and major dental, the amount of which will be determined by your health fund.

General dental – this includes basic dental treatments like routine cleanings, fluoride treatments, X-rays and small fillings.

Major dental – this is meant to cover more involved treatments like teeth extractions, crowns, bridge, and dentures. This cover might also cover orthodontics (braces), and endodontics (root canal surgery).

With some exceptions, your private health insurance fund will cover only a portion of the cost of the most common dental procedures. The rest, which you have to pay, is known as the ‘gap fee’.

Of course, it’s always important to regularly compare health insurance providers for their inclusions including any gap fee that needs to be paid.

What Is a Gap Fee?

A gap fee is the difference in price you have to pay out of pocket between the service cost of the dental treatment, and the rebate amount your health fund provides you under your extras health insurance policy. This is normally paid directly to the dental surgery.

Can I Use My Regular Dentist With My Dental Health Insurance?

Yes, you normally can use your regular dentist with your extras health insurance and still get a rebate or claim back for your service, however many health funds offer a preferred provider service. This means that they have partnered with dentists and set a maximum limit for each service that the dental surgery can charge their members.

For example, your health fund might decide that a regular check up and clean is $200 – this is the maximum amount the preferred provider dentist can charge you for that service. This is then offset by your rebate. Your dentist might even decide to waive the gap fee for you (if you’ve looked after your chompers).

How Much Rebate Can I Receive With My Dental Health Insurance?

The gap you have to pay is determined by the amount set by your health fund and extras health insurance policy you have selected. As mentioned above, the rebate will also be impacted if you visit a preferred provider. For example, your dental health insurance policy might state that you will receive 60% rebate per service. For those of you in NSW, a great way of making sure you’re getting the best rebate for your needs is to do a health insurance comparison for NSW dentists.


Are There Any Limits For Dental Health Insurance?

Yes, normally your health fund will place an annual limit on how much you can spend on each service. This does differ between your policy and your health fund. To make sure you’re getting the best limits for your dental treatment, then hop onto Billy Explores and do a provide health insurance extras comparison!

Do I Have To Sit Out A Waiting Period?

Normally waiting periods are required for new health insurance policies that include dental. The Private Health Insurance Ombudsman states that major dental procedures like crowns, bridges, or orthodontics commonly incur waiting periods of up to 12 months. However, these waiting periods are at the discretion of your health fund and can be waived in specific circumstances.

For general dental treatments, again it depends on the health fund, however normal waiting periods are around 1 to 3 months.

If you need dental treatment sooner, then it’s best to compare health insurance providers through Billy Explores and get the best deal for your needs.

What Dental Health Insurance is Best?

Obviously this is a very difficult question to answer as every person’s needs are different! The policy you choose will impact your premium, rebates, gap fee and cover. The best dental insurance is going to depend on the premium you can afford to pay, with the greatest coverage and rebates for your needs, therefore offering more treatment options and a lower gap. As we always say, make sure that you get the best dental health insurance for your needs and do a private health insurance extras comparison.

Compare Health Insurance Providers For Dental Health Insurance

The best way to get the best dental health insurance for your needs is to do an extras health insurance comparison and compare health insurance providers through Billy Explores! Billy Explores can certainly help you in comparing health insurance in Australia. You can find the best health insurance cover for your general dental and major dental needs from our panel of providers here.


  • Do I need dental health insurance?

    It is recommended you have dental health insurance if you visit the dentist regularly, or know you have major dental work that will need to be done. It’s best to do a private health insurance extras comparison through Billy Explores to make sure you get the right dental health insurance for your situation.

  • What Are The Waiting Periods For General Dental and Major Dental?

    These will be set by your health fund, however the Private Health Insurance Ombudsman advises that major dental procedures like crowns, bridges, or orthodontics normally have a waiting period of up to 12 months. General dental waiting periods are normally around 1 to 3 months.