Implant costs / Medicare and extras
Medicare, CDBS and extras cover for dental implants
Medicare and extras cover rarely pay much toward dental implants. Medicare does not pay for them for most adults. Private extras cover may pay a small part under major dental, after a waiting period.
This page sets out what each scheme does and does not pay, in plain words.
Medicare and dental implants
Medicare is Australia's public health scheme. It pays for doctors and hospital care, but it largely leaves out the dentist. That means an implant placed in a normal dental chair gets no Medicare rebate.
Finder names two main exceptions:
- Some concession card holders can use state dental services or vouchers.
- Children in eligible families can use the Child Dental Benefits Schedule for basic care.
Neither one is a general way to pay for an adult implant.
Source: Finder.
The Child Dental Benefits Schedule
The Child Dental Benefits Schedule, or CDBS, started in 2014. It gives eligible children a capped benefit for basic dental services. The cap runs across two calendar years.
Services Australia says a child must meet all of these to use it:
- be 0 to 17 years old for at least one day in that calendar year
- be eligible for Medicare
- get a payment from Services Australia at least once a year, or have a parent, carer or guardian who does
You can check if your child is eligible and see the balance in your Medicare online account through myGov, or by calling the Medicare line. The scheme is for basic care. Ask the dentist to confirm what is covered before any work starts, since an implant is a major job.
Sources: Services Australia; Department of Health CDBS page; health.gov.au.
Public dental clinics
Each state and territory runs public dental services. Rules on who can use them differ by state, and each state sets its own list. The Australian Government lists the service for each state on its dental health page:
| State or territory | Public dental service |
|---|---|
| New South Wales | NSW Health oral health services |
| Victoria | Department of Health, public dental care |
| Queensland | Queensland Health dental services |
| Western Australia | Dental Health Services |
| South Australia | SA Dental |
| Tasmania | Oral Health Tasmania |
| Australian Capital Territory | ACT Health dental services |
| Northern Territory | Department of Health dental services |
Check your state's site to see if you qualify and what kinds of care it offers. Not every public service places implants.
Source: health.gov.au.
Private extras cover and major dental
Extras cover is the part of private health insurance that pays toward things like dental, physio and glasses. Finder says implants sit in the major dental group, along with crowns, root canals and gum treatment. Major dental is mostly found on mid level and top level policies.
Three rules decide how much you get back.
The waiting period
Most funds make you hold major dental for a year before the first claim, Finder says. If you join now, plan around that.
The yearly limit
Finder says major dental limits often sit at A$500 to A$800 a year. Some top policies go to A$1,000 or more. Once you reach the limit, the fund pays nothing more that year.
Sublimits and lifetime caps
Some policies put implants under a smaller sublimit, a shared limit with other items, or a lifetime cap. The product disclosure statement, or PDS, sets out which applies to you.
Source: Finder.
A worked example
Here is how the limit plays out.
- You have held a policy for more than 12 months.
- Its major dental limit is A$800 a year.
- Your quote for one implant is A$4,500.
- Most the fund can pay this year: A$800
- Least you still pay: A$4,500 take away A$800, which is A$3,700
If the policy pays a set share of each item rather than up to the limit, you may get back less than A$800. Ask the fund for a written estimate using the item numbers on your quote.
Example uses the major dental limit range from Finder. The quote figure is a sample within Finder's A$3,000 to A$7,000 range.
Hospital cover
Hospital cover pays only when you are admitted to hospital as an inpatient.
- An implant placed in the dental chair, with no hospital admission, falls outside hospital cover.
- Finder says it may help when there are special anaesthetic needs or a large bone graft.
- Check your own hospital policy to see whether dental surgery is covered.
Source: Finder.
Questions to ask your health fund
- Is dental implant work covered on my policy, and under which group?
- Have I served the waiting period for major dental?
- What is my yearly limit, and how much of it have I used?
- Is there a sublimit or lifetime cap for implants?
- What will you pay for each item number on this quote?
- Does the benefit change if I use a dentist in your network?
Ask for the answers in writing. Then you can work out the real amount you will pay before you agree to any work.
For the cost of the work itself, see dental implant prices in Australia. For ways to spread the bill, see paying for implants.
Medicare and extras questions
Will Medicare pay for my dental implant?
In most cases it will not. Finder notes that Medicare largely does not cover dental work, including implants.
Can the Child Dental Benefits Schedule pay for an implant?
The CDBS pays a capped benefit for basic dental services for eligible children aged 0 to 17, over two calendar years. Ask the dentist whether a given item is on the schedule before treatment starts.
How long must I wait to claim implants on extras?
Finder says there is usually a 12 month waiting period before you can claim for major dental, which is where implants sit on most policies.
Does hospital cover pay for implants?
Only in some cases. Finder says hospital cover may help if you are admitted as an inpatient, for example for special anaesthetic needs or large bone grafts.
Check your own policy for what it pays.
Answers drawn from Finder and Services Australia.