Private health insurance

In Australia, the private health insurance system is based on individuals or families purchasing an insurance policy that covers all or part of the cost of health care. Private health insurance cover is generally divided into hospital cover, general treatment cover and ambulance cover. General treatment cover provides insurance against costs of treatment by ancillary health service providers, including dentists. The extent of cover depends on the type of policy purchased.

Key terms

  • Dentate: Having one or more natural teeth.
  • Edentulous: A state of complete loss of all natural teeth.
  • Constant prices: Constant price expenditure adjusts current prices for the effects of inflation over time— see Glossary in Health expenditure Australia 2018–19.

Data in this section were sourced from the National Dental Telephone Interview Survey 2013 (AIHW 2016). This section reports the proportion of Australians who held private health insurance cover for dental expenses at the time of the survey.

Half (50%) of all people aged 5 years and over had some level of private health insurance cover for dental expenses

The proportion of people aged 5 years and over with some level of private health insurance cover for dental expenses was:

  • higher for adults aged 45–64 (57%) than those aged 15–24 (44%)
  • twice as high for dentate people (51%) than edentulous people (25%).

Explore the data using the Private health insurance interactive 1 below.

Private health insurance – Interactive 1: 
This figure shows the proportion of people aged 5 years and over with private health insurance cover for dental expenses, by dental status. National data is presented for 2013. In Australia, 49.7% of people aged 5 years and over had private health insurance cover for dental expenses in 2013.

Nearly twice as many dentate people aged 5 years and over ineligible for public dental care (58%) had some level of private health insurance cover for dental expenses than those eligible for public dental care (31%)

The proportion of dentate people aged 5 years and over with some level of private health insurance cover for dental expenses:

  • was similar for males (50%) and females (52%)
  • higher for those living in Remote and very remote areas (57%) than those living in Major cities (53%), Inner regional (45%) and Outer regional (44%) areas
  • increased as annual household income increased, from 23% for those earning less than $30,000 per year to 78% for those earning over $140,000 per year.

Explore the data using the Private health insurance interactive 2 below.

Private health insurance – Interactive 2: This figure shows the proportion of people aged 5 years and over with private health insurance cover for dental expenses, by selected characteristics. National data is presented for 2013. In Australia, 49.5% of males and 51.8% of females aged 5 years and over had private health insurance cover for dental expenses in 2013.

Around 3 in 4 (77%) adults aged 18 years and over reported that their insurance paid some of the dental expenses of their last visit

  • Around 1 in 12 (8.5%) adults aged 18 years and over reported that their insurance paid all the dental expenses of their last visit.
  • Around 1 in 10 (10%) adults aged 18 years and over reported they paid all their own dental expenses of their last visit.

Around 1 in 5 (19%) of insured adults aged 18 years and over who paid all their own dental expenses reported that dental care caused a large financial burden

  • Around 1 in 25 (4.1%) of insured adults aged 18 years and over whose insurance paid all of the dental expenses reported that dental care caused a large financial burden.
  • Around 1 in 10 (10%) of insured adults aged 18 years and over whose insurance paid some of the dental expenses reported that dental care caused a large financial burden.

Explore the data using the Private health insurance interactive 3 below.

Private health insurance – Interactive 3: 
This figure shows the use of private health insurance cover for dental expenses for adults aged 18 years and over, by source of payment. National data is presented for 2013. In 2013, 77.3% of adults reported that both their health insurance paid some and they paid some of their dental expenses.

Health expenditure by private health insurance funds

In 2018–19, 12.3 million Australians (48%) were covered by a general treatment policy (excluding ambulance only cover) (APRA 2021) and dental services attracted $2.1 billion (12%) of expenditure by private health insurance funds (AIHW 2020).

Net benefits paid by private health insurance funds for dental services increased from $1.9 billion in 2016–17 to $2.1 billion in 2018–19

Explore the data using the Private health insurance interactive 4 below.

Private health insurance – Interactive 4: This figure shows the expenditure by private health insurance funds on dental services. National data is presented for 2016–17 to 2018–19. In 2018–19, private health insurance funds paid around $2.1 billion in net benefits.

Private health insurers data

The General Treatment Dental (GT-Dental) data collection contains de-identified unit record information relating to patients and general treatment dental services for which the private health insurer paid a benefit. This information is reported to the Commonwealth Department of Health by private health insurers (Department of Health 2017).

In 2017–18, across Australia the median charge, benefit and gap for a diagnostic comprehensive oral examination was $59, $40 and $18, respectively

In 2017–18, across Australia:

  • the median charge, benefit and gap for a preventative service involving the removal of plaque and/or stain was $58, $38 and $16, respectively
  • the median charge, benefit and gap for a restorative service involving the adhesive restoration of one surface of an anterior tooth was $139, $72 and $60, respectively
  • the median charge, benefit and gap for the removal of a tooth or part(s) thereof was $156, $83 and $76, respectively
  • the median charge, benefit and gap for a full crown was $1500, $700 and $786, respectively

Explore the data using Private health insurance interactive 5 below:

Private health insurance – Interactive 5:
This figure shows the charge to patient, the benefit paid and the gap for private dental services in Australia, by median (50th percentile) and 90th percentiles, by service type and by procedure type. National, state and territory data is presented for 2010–11 to 2017–18. In 2017–18, the median charge in Australia for a comprehensive oral examination was $59.

In 2017–18, the charge for a diagnostic comprehensive oral examination ranged from $28 to $101, the benefit ranged from $17 to $75 and the gap ranged from $0 to $69 across Australia

In 2017–18, across Australia:

  • the charge for a preventative service involving the removal of plaque and/or stain ranged from $22 to $110, the benefit ranged from $14 to $74 and the gap ranged from $0 to $82
  • the charge for a restorative service involving the adhesive restoration of one surface of an anterior tooth ranged from $46 to $260, the benefit ranged from $21 to $146 and the gap ranged from $0 to $199
  • the charge for the removal of a tooth or part(s) thereof ranged from $50 to $350, the benefit ranged from $21 to $172 and the gap ranged from $0 to $278
  • the charge for a full crown ranged from $700 to $2,500, the benefit ranged from $41 to $1,300 and the gap ranged from $26 to $1,989.

Explore the data using Private health insurance interactive 6 below:

Private health insurance – Interactive 6: |This figure shows the range (percentiles) of charge to patient, the benefit paid and the gap for private dental services, by category and procedure. National data is presented for 2010–11 to 2017–18. In 2017–18, the charge for a diagnostic comprehensive oral examination ranged from $28 to $101, the benefit ranged from $17 to $75 and the gap ranged from $0 to $69 across Australia.

In 2017–18, more dental services for which the private health insurer paid a benefit were provided to females (around 17.5 million) than males (around 14.3 million) 

For services where the private health insurer paid a benefit in 2017–18:

  • Over half (54%) of dental services were provided to those in the 35–69 age group
  • around 983,000 services were provided to males aged 10–14 years compared with around 955,000 services provided to females of the same age.

Explore the data using Private health insurance interactive 7 below:

Private health insurance – Interactive 7: 
This figure shows the number of private dental services, by age group and sex. National, state and territory data is presented for 2010–11 to 2017–18. In 2017–18, more dental services for which the private health insurer paid a benefit were provided to females (around 17.5 million) than males (around 14.3 million).