Usually yes, as long as you have extras cover. A routine check-up falls under general dental, and most funds pay a benefit towards it, or cover a preventive check-up and clean in full once or twice a year. The catch is in the detail: whether you pay a gap depends on your level of extras, your annual limit, any waiting periods, and whether your dentist is one of your fund’s preferred providers. Two things worth knowing up front: hospital cover on its own will not cover a routine check-up, and Medicare does not cover general dental for adults. So the cover you need is extras, sometimes called general or ancillary cover.
What type of cover you actually need
Private health insurance comes in two parts, and only one of them pays for a check-up:
- Extras (general treatment) cover: this is the one that covers dental. It includes general dental like check-ups, cleans, x-rays, fluoride and fillings.
- Hospital cover: this pays for treatment you have admitted to hospital, such as wisdom teeth removed under general anaesthetic. It does not cover a routine check-up.
Medicare sits outside both. It does not cover routine dental for adults, though there are exceptions for eligible children under the Child Dental Benefits Schedule and for concession-card holders through public dental. If health funds are new to you, our guide on whether your health insurance covers dental care walks through it in more detail.
What a check-up claims under
On your extras policy, a check-up and clean is usually made up of a few separate items under general (preventive) dental:
- A periodic oral examination, which is the check-up itself
- A scale and clean to remove plaque and tartar
- X-rays, when they are needed
- Fluoride treatment, often for children
These sit under general dental, which most funds cover generously. Bigger work like crowns, bridges and implants falls under major dental, which is a separate category with lower benefits and often longer waiting periods. The difference between the two is explained well in our post on preventive versus major dental insurance coverage.
Will I still pay a gap?
Sometimes yes, sometimes no. The gap is the difference between what the dentist charges and what your fund pays back. Whether you have one comes down to three things:
- Your level of extras. A basic policy pays a smaller benefit than a top-level one.
- Your annual limit. Funds cap how much you can claim on general dental each year. Once you hit the limit, you pay the rest yourself.
- Preferred providers. Many funds have a network of preferred dentists where a preventive check-up and clean is covered with no gap, usually once or twice a year. Away from that network, you may pay a small gap.
The simplest way to know is to ask. Your fund can tell you your benefit for a check-up, and any clinic can check it for you before your appointment.
Waiting periods and annual limits
Two things trip people up on a new policy. First, waiting periods: general dental usually has a waiting period of around two months on a new extras policy, so you cannot join today and claim tomorrow. Second, annual limits: your general dental benefit resets each calendar year, and unused limit does not roll over. If you are due for a check-up late in the year, it can be worth booking before your limit resets.
How to check what your check-up will cost
You have three easy ways to find out before you are in the chair:
- Read your policy or fund app. Look for your general dental benefit and your remaining annual limit.
- Call your fund. Give them the check-up and clean item numbers and ask what you will get back.
- Let the clinic claim on the spot. Most clinics swipe your health fund card through a HICAPS terminal, so your rebate comes off straight away and you only pay any gap.
What if I do not have private health insurance?
You can still get a check-up. You pay privately, which for a check-up and clean in Australia generally sits around $150 to $300, or you may qualify for lower-cost care. Concession-card holders can use public dental, and eligible children are often covered through the Child Dental Benefits Schedule. Either way, a regular check-up is the cheapest dentistry you will ever do, as our post on the benefits of regular dental check-ups explains.
Frequently asked questions
Is a dental check up covered by private health insurance? Usually yes, if you have extras (general) cover. Most funds pay a benefit towards a check-up and clean, and many cover a preventive visit in full once or twice a year at a preferred provider. Whether you pay a gap depends on your level of cover, your annual limit and any waiting periods. Hospital cover alone does not cover a routine check-up.
Does hospital cover include dental check-ups? No. Hospital cover is for treatment you are admitted to hospital for, such as surgical wisdom teeth removal. Routine check-ups are covered under extras (general) cover, which is a separate part of your policy.
Does Medicare cover dental check-ups? Not for adults. Medicare does not cover routine dental. The main exceptions are eligible children under the Child Dental Benefits Schedule, and concession-card holders who can access public dental.
