Not everyone is fortunate to have “gold standard” health insurance coverage to take care of every possible combination of health care situation.

When it comes to dealing with dental care, having a private dental health insurance plan is your best option to deal with unexpected dental costs.

However, what is the right type of dental coverage for you? 

​Like most things in life - private dental coverage is not a 'one size fits all' solution, so picking the right plan from the outset is imperative. If you don't, you'll pay hundreds more than you need to, or worse, risk being improperly covered when you need it most.

There are an overwhelming number of plans to choose from, with different options available (and an overwhelming amount of fine print to read through).

Lets clear up the dental health insurance myth in Australia so that you can make a confident and informed decision.


How It Works: Health Insurance Dental

In Australia, you don't specifically look for ONLY dental coverage per se, as dental coverage will fall under your health insurance plan.

Basic dental treatments are usually covered by your health insurance plan by default (regular check-ups, cleaning etc.) and you have the option to add on extra’s dental cover for an extra premium (which will cover you for larger dental procedures)

It's best that you review your cover from time to time as you evolve to ensure your policy is still meeting your healthcare needs.

Types Of Coverage - Whats Best For You?

Dental Insurance in Australia

Typically, dental coverage is available in one of two ways in Australia: general and major dental. Exactly what is classified as general or major is not black or white; it varies from one health insurance provider to the next, but in general, according to PrivateHealth.gov.au:

  • General dental coverage: This refers to annual checkups, cleaning & fluoride treatment, minor fillings, and in general, most types of preventative dental work.

  • Major dental coverage: As the name suggests this includes major dental procedures such as complex fillings, tooth extractions, crowns, bridges and orthodontics. 

Cosmetic dental work, which is anything that enhances appearance and is not medically necessary (e.g. teeth whitening or dental implants) is NOT covered by health funds or Medicare.

Lots of health funds offer basic levels of coverage as standard inclusions, with additional coverage options available as “extras”.

Typically, the basic “extra's” coverage usually includes General dental procedures only.

Additional “extras” options are usually offered that include treatments under both General and Major dental categories.

Q:

"So, Should I go for a health fund that covers general dental, or look for a plan that covers general + extra coverage for major dental work?"

A:

Selection of an appropriate type of policy is largely a function of your individual dental coverage requirements - For example:

  • Young individuals (or couples), whose dental health is relatively good, may opt for general coverage

  • Families or elderly individuals may be better served opting for a plan that provides major dental coverage.

If you are relatively young and your teeth are in good health, there is generally no need to spend money on a plan that covers you for major dental complications. A basic plan that covers you for general dental, will be good enough; just make sure you take advantage of the discounted preventive dental benefits to ensure your teeth stay in good shape!

If you feel like you will need an expensive procedure at some point in the future, for example, dental implants or dental veneers, then a higher level of cover is going to cost you more in the short term but save you more in the long run.

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How To Choose Dental Health Insurance

With so many health insurance providers available to choose from, it’s hard to decide whom to select as your provider of choice.

​If you're a young single or couple, and are in good shape then you may only need general dental cover. However, if you're a family or older couple it's best to consider major dental that covers all possibilities including orthodontics/braces, wisdom teeth removal and dentures.

Always do your own research and make decisions based on your own unique circumstances (rather than taking advice from your know-it-all neighbour)

Start by looking at the following obvious factors.

Factors To Take A Closer Look At

Factor to consider

Description

Your age

Extra dental coverage may be required as you get older

The state of your dental health

Some seniors have enviable dental health, while some young adults may have severe dental issues. Select your coverage based on what your individual needs are.

Your financial state

Individuals that are in a high-income bracket, or those that are already enrolled in an employer-sponsored "gold standard" health care plan may not find extra coverage overly beneficial.

The economics of it

Though individuals may enjoy great dental health, dental insurance should be decided upon based on the economies of the collective family unit. The larger the family, the greater the potential for dental expenditure, which might require extra coverage.

When choosing your insurance provider, look for “freebies” that are offered.

In some cases, a fund might offer priority dental appointments to its members. What this means is that members get preferential treatment when it comes to booking appointments or seeing a dentist, even if it is an unscheduled visit. For busy individuals this might be an invaluable perquisite because of their hectic schedules.

Your dental cover rebates will vary significantly depending on the level of “extras” you opt for.

Reading the fine print

Remember to check up on the following before committing to a policy:

  • What are the annual limits?  Most funds will typically set an annual limit for each of the “extras”, while others may not have limits for certain extra coverage (such as Preventable checkups etc.) options. The lower the limit, the less you will benefit.

    The higher the annual limits, the more you'll save

  • Is there a waiting period? Make sure you read the fine print on how long your fund expects you to wait before any type of dental procedure is performed.  Some funds have a 2 month waiting period (for General and Preventive procedures), while Major dental procedures could have wait times of up to 12 months.

    The maximum allowable waiting period is 12 months, so ideally look for something with a shorter waiting period.

  • What will my out of pocket expenses be? always ask what out of pocket expenses will be for general and major dental procedures, to get a good idea of how much you will benefit. Even though you are paying for coverage, there will generally be out of pocket expenses.

    Pick 5 dental procedures (a few general, and a few major) and ask a few health insurance providers what your out-of-pocket expenses will be.

  • Do you offer 'no gaps' benefits? Some funds offer “NO GAP” provisions to their members; what that means is that members have no gap (out of pocket payment) to incur when they visit their dentist for procedures such as check-ups, removal of plaque, cleaning, x-rays and other routine treatments.

    Most good providers will offer a no gap option nowadays

PRO TIP: Keep your eye out for “special offers” from funds, during which they may waive (or reduce) the wait times associated with some of the “extras”. This is the best time to sign up to a new health insurance provider – during a sale!

Dentist and a female patient

A Review Of The Best Health Insurance For Dental Plans In Australia


With so many providers available to choose from, it’s hard to decide whom to select as your provider of choice. Since dental coverage falls under your health insurance plan, a very common question we get asked is: "What is the best health insurance for dental?"

Here are a few that you may like to take a closer look at for general and major dental care:

The Best Dental Insurance For General Dental Coverage


Chances are that you already have private health coverage, but the confusing question is, exactly what type of dental work are you covered for?

If you you have ancillary or extras with your health insurance cover, you should be able to get free (or low cost) preventative dental care, which is the best way to prevent expensive dental complications from arriving in the future.

PRO TIP: If you current health insurance provider does not provide you with reduced cost or free preventative dental care, consider moving to a company that does. Prevention is always better than the cure.

The following companies are a great choice if you're looking for basic health coverage

Provider

Participating Dentists

Description

NIB

Has dental centres in Sydney, Wollongong and Newcastle + 7 regional centres (NSW only)

  • ​Waiting period - 2 months (general) and 12 months (major dental)

  • No GAP benefits  - checkup, clean and fluoride treatment

  • Annual limits - range from unlimited (for Preventative) to $1,300 for Major dental coverage.

  • Dental plans are structured in a way that can offer you between 60% to 75% back on your dental visits. What that means is a $200 visit could get you back between $120 and $175 back

Find out more about NIB dental care

Health Insurance Fund of Australia (HIF)

Visit any registered dentist in Australia

  • Waiting period - 2 months (general dental) and 12 months (major dental). They will waive your waiting period if you come from another health fund to a similar plan!

  • No Gaps benefits - Not available

  • Annual limits -  Unlimited for preventative dental work. Ranges from up to $1500 (first year) to $3000 (subsequent years) for major dental.

Individuals looking for a starter, low cost private dental policy might find HIF's 'Saver Options' an attractive choice, with annual limits per person starting at $750 and reaching up to $1,250 after 5 years

Find out more about HIF dental insurance

GMF Health

Visit any registered dentist in australia

  • Waiting period - 6 months (general) and 12 months (major dental)

  •  No gaps benefits - not available
     
  • Annual limits - Depends on the plan. For general dental limits on the mid priced plan, $800/year from years 1-5, and $2000/year from year 5+.

    For major dental its $850/year from years 1-5 and $2000/year from years 5+

GMF also offers three levels of Dental "extras", ranging from $4.80 per week to $11.60 per week.

Find out more about GMF dental insurance

Health Insurance Providers For Major Dental Coverage


If you're looking for a dental health plan that offers a little extra coverage for major dental work, consider the following companies. We've included the general dental benefits as well, because they are still part of the plan.

Remember, each provider has different ideas on what is considered major dental or not, so be sure to call and confirm beforehand.​

Provider

General Dental

Major Dental

Australian Unity

  • ​Waiting period - 2 months

  • No gap benefits - available for selected providers

  • Annual limit on general dental - unlimited
  • ​Waiting period - from 2 to 12 months, depending on the procedure

  • Major dental annual rebate - Up to $1300

La Trobe Health Services

  • ​Waiting period - 3 months

  • No gap benefits - not available

  • Annual limit on general dental - unlimited
  • ​Waiting period - from 3 to 12 months, depending on the procedure

  • Major dental annual rebate - Up to $1500

GMF Health

  • ​Waiting period - 6 months

  • No gap benefits - not available

  • Annual limit on general dental - $850/year
  • Waiting period - 12 months 

  • Major Dental annual limit - $850/year from years 1-5 and $2000/year from years 5+

After reviewing the above information on major dental cover, you're probably thinking :

"Coverage for major dental procedures in Australia is quite weak"

And you're right! Unfortunately, Australian health insurance providers do not provide amazing benefits by any means for patients seeking major dental work. Considering that some procedures can cost in the tens of thousands of dollars, it's just to risky in their eyes.

While certain health providers do provide levels of coverage of up to $2000, you can only access this rebate once you've been with the company for 5 + years.

For this reason, it's not hard to see why many Australians are choosing to fly to countries where medical work can be done for a fraction of the price.​


Your Preparation: The Best Dental Coverage

Health insurance exists to ensure that you're protected in case of unexpected dental costs (e.g. Root Canal Costs – which can be VERY VERY expensive if you’re not prepared, or wisdom teeth removal, which always seem to cost more than you were quoted for!)

As we age, we become more susceptible to diseases, including dental decay and orally borne illnesses – thats a fact we have to live with.

As we've revealed, coverage for major dental work is limited in Australia, meaning you'll likely have to fork out a good deal of your own savings if you unexpectedly require any type of major dental work. So what can you do about?

Prevention is better than the cure - always strive to take care of your teeth and this means making use of your health funds general/preventative benefits: make use of the free regular checkups and subsidies preventive dental care!

Key Takeaways

  • Don't leave choosing a dental health plan until it's too late - join a policy that has great general dental coverage ASAP and start making use of your preventative dental care benefits.

  • Always read the fine print - Before signing up to a plan, to ensure you're getting the best benefits your money can buy. These points are what you should be looking at.

  • Plan ahead for the chance of major dental work - You now know that your health insurance coverage will be limited and weak at best, so have a backup plan ready to go. This can be either putting away savings, asking your dentist if they offer payment plans, or considering dental tourism to save money.

Being covered by an appropriate dental health insurance plan will help relieve the stress of having to deal with such unexpected costs.

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