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 private 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— see Glossary in Health expenditure Australia 2017–18.

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.

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.

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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.

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Health expenditure by private health insurance funds

In 2017–18, 12.3 million Australians (49%) were covered by a general treatment policy (excluding ambulance only cover)(APRA 2020) and dental services attracted $2.0 billion (12%) of expenditure by private health insurance funds (AIHW 2019).

Net benefits paid by private health insurance funds for dental services increased from $1.8 billion in 2015–16 to $2.0 billion in 2017–18

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

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

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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.

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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:

References

AIHW (Australian Institute of Health and Welfare): Chrisopoulis S, Harford JE & Ellershaw A 2016. Oral health and dental care in Australia: key facts and figures 2015. Cat. No. DEN 229. Canberra: AIHW.

Australian Institute of Health and Welfare 2019. Health expenditure Australia 2017–18. Cat. no. HWE 077. Canberra: AIHW. doi:10.25816/5ec5ba12ed174

APRA (Australian Prudential Regulation Authority) 2020. Private health insurance membership and coverage, March 2020. Sydney: APRA

Department of Health, 2017. Hopsital Data Collections. Canberra: Australian Government Department of Health. Viewed 18 June 2020