If you have ever stood at the front desk wondering whether Medicare will cover your dental bill, you are not alone. It is one of the most common questions we hear at Eglinton Dental Care, and the honest answer is a bit more detailed than a simple yes or no. This guide breaks down what Medicare actually pays for at the dentist, who the Child Dental Benefits Schedule covers, how public dental works here in Western Australia, and where private health extras fit into the picture.
We will keep this plain and practical, because dental costs are confusing enough without jargon getting in the way.
Does Medicare cover dental for adults?
For most adults, the short answer is no. Medicare is built around medical care, not everyday dental treatment, so routine check-ups, fillings, cleans and extractions for adults are not covered by the standard Medicare card. This surprises a lot of people who assume dental is treated the same as seeing a GP.
There are a few narrow exceptions, such as dental care linked to certain chronic medical conditions managed through a care plan, or dental treatment carried out as part of a hospital stay in specific circumstances. These situations are the exception rather than the rule, and your GP or specialist would usually be the one to set that up. For the vast majority of everyday dental visits, adults need to either pay privately, use private health extras, or look at the public dental system if they are eligible.
Does Medicare cover dental for kids? The Child Dental Benefits Schedule
This is where Medicare does play a real role, through the Child Dental Benefits Schedule, usually shortened to CDBS. According to Services Australia, to get this your child must be 0 to 17 years old for at least one day that calendar year, getting a payment from Services Australia at least once a year, or have a parent, carer or guardian getting a payment from them at least once a year.
If your child meets those conditions, CDBS covers fissure sealing, fillings, root canals, extractions and partial dentures, along with check-ups, x-rays and cleaning. It does not cover everything though. Benefits are not available for orthodontics, cosmetic dental work or any services provided in a hospital.
There is also a cap on how much can be claimed. The 2 year period starts at the beginning of the calendar year in which your child both meets the eligibility rules, and you can use the full amount for each eligible child in the first calendar year. This cap is indexed each year, so rather than quote a figure that may be out of date by the time you read this, we would encourage you to check the current amount directly on the Services Australia website, or ask our team to check it for you at your child's visit.
You can check your child's CDBS eligibility and remaining balance through your Medicare online account via myGov, or through the Express Plus Medicare app. It only takes a few minutes, and it is worth doing before you book, so there are no surprises.
What CDBS does not cover
- Orthodontic treatment, such as braces or clear aligners
- Cosmetic dental work
- Any dental services provided in a hospital
If your child needs something outside this list, we will always talk you through what is involved and what the options are before any treatment starts.
Bringing your child in under CDBS
At Eglinton Dental Care, families and children are genuinely welcome, and we understand that a first dental visit can feel like a big step for both you and your little one. Our team takes things at your child's pace, explains what we are doing in simple terms, and answers any questions you have along the way. If your child is eligible, we can check their CDBS details and let you know what is likely to be covered before we go ahead. You can read more about what to expect on our children's dentistry page, or get in touch if you are not sure whether your child qualifies.
Public dental in WA
Outside of CDBS, Western Australia also runs its own public dental system through Dental Health Services. According to Dental Health Services WA, if you have a Health Care or Pensioner Concession card you are eligible for subsidised public dental care through Dental Health Services.
Public dental clinics also look after children in a couple of ways. Children aged 0 to 4 whose name appears on their parent's health care or pension concession card are also eligible to attend a general dental clinic for care, and children and teenagers aged 5 to 16 attending school are eligible for the free School Dental Service. Public dental care covers the basics well, but it generally runs on a referral and waiting list system, and more complex treatment is often referred out to other providers.
Many Eglinton, Alkimos and Butler families choose a private dentist instead, simply because it means you can usually book in sooner and see the same dentist over time. That is where a local practice like ours can help, whether you are eligible for public dental or not.
What about private health extras?
If you hold private health extras cover, that is separate from Medicare entirely. Medicare and private health funds work differently, and dental sits almost entirely under extras cover rather than the Medicare side of things.
At Eglinton Dental Care, we are not a preferred provider for any particular health fund, which simply means we treat every patient the same way regardless of which fund they are with. Bring your health fund card along to your appointment, and in most cases we can process your rebate on the spot through HICAPS, so you only need to pay the gap between what your fund covers and the total cost. We always talk through the treatment plan and the likely costs before we start anything, so there are no surprises, and there is never any pressure to go ahead on the day.
If you are weighing up extras cover, it is worth remembering that most funds reset their annual limits on 31 December, though it is worth checking your own fund's reset date, since not all of them follow the calendar year exactly.
So, does Medicare cover dental in Australia overall?
Pulling it all together: Medicare on its own does not cover general dental care for most adults. It does help cover a defined list of basic services for eligible children through CDBS. Outside of that, public dental through WA Health Dental Health Services exists for cardholders and school-aged children, and private health extras cover is the main way most working adults and families manage everyday dental costs.
If you are new to the area and still working out which option applies to your family, our team is always happy to talk it through. You can find more general information on our FAQ page, or learn a bit more about our approach on our about page.
Frequently asked questions
Does Medicare cover dental x-rays?
For adults, no, Medicare does not generally cover dental x-rays as part of routine care. For eligible children under CDBS, x-rays are included as one of the basic services covered, alongside check-ups and cleaning.
Can adults use the Child Dental Benefits Schedule?
No, CDBS is only for children who meet the age and payment eligibility rules set out by Services Australia. Adults need to rely on private health extras, out-of-pocket payment, or WA's public dental system if they hold a Health Care or Pensioner Concession card.
What happens if my child's CDBS balance runs out part way through treatment?
Once the benefit cap for the two year period is used up, no further CDBS benefits are paid until a new cover period begins. We will let you know where things stand before any treatment goes ahead, so you can decide how to cover the rest, whether that is through private health extras or paying the gap yourself.
Is public dental in WA free?
Not always. Public dental through Dental Health Services is subsidised for eligible cardholders, but some patients may still pay a portion of the cost depending on their circumstances, and non-urgent care often involves a waiting list.
How do I check if Medicare or CDBS covers a specific treatment?
The easiest way is to ask us directly. We can check eligibility and talk you through which item numbers apply, and you are always welcome to confirm details yourself through your Medicare online account or by calling Services Australia.
Modern dentistry with a gentle touch is what we aim for at Eglinton Dental Care, whether you are bringing in a nervous toddler for their first check-up or sorting out your own dental care as a new resident of the northern suburbs. If you have questions about Medicare, CDBS or what your health fund will cover, give our team a call on 08 9564 1007, or choose a time online through our booking page. We are based at 1K Imperial Entrance, Eglinton, and we keep some appointments free each day for dental emergencies, so do not hesitate to reach out if something is bothering you.
