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 not covered by Medicare.

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

Private health insurance cover for dental expenses

Data in this section were sourced from the National Dental Telephone Interview Survey (NDTIS) 2013 (AIHW 2016) and the NDTIS component of the National Study of Adult Oral Health 2017–18 (ARCPOH unpublished). This section reports the proportion of Australians who held private health insurance cover for dental expenses at the time of the surveys.

In both survey periods, around 1 in 2 people aged 5 years and over had some level of private health insurance cover for dental expenses

In 2017–18, the proportion of people aged 5 years and over with some level of private health insurance cover for dental expenses was:

  • higher for children aged 5–14 (55%) than adults aged 65 years and over (46%)
  • higher for dentate people (53%) than edentulous people (22%).

These trends were similar to those observed in 2013.

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.

In 2017–18, more dentate people living in Major cities (56%) had some level of private health insurance cover for dental expense than those living in any other area

In 2017–18, 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 (51%) and females (54%)
  • higher for those ineligible for public dental care (61%) than those eligible for public dental care (32%)
  • increased as annual household income increased, from 30% for those earning less than $30,000 per year to 83% for those earning over $140,000 per year.

These trends were similar to those observed in 2013.

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 and 2017-18. In Australia, 51.1% of males and 54.3% of females aged 5 years and over had private health insurance cover for dental expenses in 2017-18.

In 2017–18, around 3 in 4 (76%) adults aged 18 years and over reported that their insurance paid some of the dental expenses of their last visit

Also in 2017–18:

  • Around 1 in 8 (12%) adults aged 18 years and over reported that their insurance paid all the dental expenses of their last visit.

  • Around 1 in 11 (8.8%) adults aged 18 years and over reported they paid all their own dental expenses of their last visit.

In 2017–18, 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

Also in 2017–18:

  • Around 1 in 10 (9.7%) insured adults aged 18 years and over whose dental expenses were paid for by the Government reported that dental care caused a large financial burden.
  • Around 1 in 10 (9.6%) 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 and 2017-18. In 2017-18, 75.7% 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 2019–20, 12.3 million Australians (48%) were covered by a general treatment policy (excluding ambulance only cover) (APRA 2021) and dental services attracted $1.9 billion (11%) of expenditure by private health insurance funds (AIHW 2021).

Net benefits paid by private health insurance funds for dental services decreased from $2.1 billion in 2018–19 to $1.9 billion in 2019–20

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 2017–18 to 2019–20. In 2019–20, private health insurance funds paid around $1.9 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 2020–21, across Australia the median charge, benefit and gap for a diagnostic comprehensive oral examination was $60, $45 and $14, respectively

In 2020–21, across Australia:

  • the median charge, benefit and gap for a preventative service involving the removal of plaque and/or stain was $60, $40 and $18, respectively
  • the median charge, benefit and gap for a restorative service involving the adhesive restoration of one surface of an anterior tooth was $147, $74 and $71, respectively
  • the median charge, benefit and gap for the removal of a tooth or part(s) thereof was $175, $83 and $90, respectively
  • the median charge, benefit and gap for a full crown was $1560, $674 and $870, 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 2020–21. In 2020–21, the median charge in Australia for a comprehensive oral examination was $60

In 2020–21, the charge for a diagnostic comprehensive oral examination ranged from $30 to $110, the benefit ranged from $17 to $75 and the gap ranged from $0 to $72 across Australia

In 2020–21, across Australia:

  • the charge for a preventative service involving the removal of plaque and/or stain ranged from $25 to $125, the benefit ranged from $14 to $80 and the gap ranged from $0 to $88
  • the charge for a restorative service involving the adhesive restoration of one surface of an anterior tooth ranged from $50 to $279, the benefit ranged from $25 to $152 and the gap ranged from $0 to $212
  • the charge for the removal of a tooth or part(s) thereof ranged from $65 to $400, the benefit ranged from $27 to $198 and the gap ranged from $0 to $320
  • the charge for a full crown ranged from $750 to $2,650, the benefit ranged from $65 to $1,383 and the gap ranged from $20 to $2,165.

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 2020–21. In 2020–21, the charge for a diagnostic comprehensive oral examination ranged from $30 to $110, the benefit ranged from $17 to $75 and the gap ranged from $0 to $72 across Australia.

In 2020–21, more dental services for which the private health insurer paid a benefit were provided to females (around 19.4 million) than males (around 15.7 million)

In 2020–21:

  • most dental services for which the private health insurer paid a benefit were provided to those aged 55–59 years, around 2.7 million services
  • around 1.2 million services were provided to males aged 10–14 years compared with around 1.1 million 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 2020–21. In 2020–21, more dental services for which the private health insurer paid a benefit were provided to females (around 19.4 million) than males (around 15.7 million).