Why Is Dental Not Covered by Medicare in Australia?

Medicare will pay for a knee replacement, a cardiac stent, and an MRI scan of your brain. It will not pay for a dentist to pull an infected tooth.

For most Australians, this is simply how things are — an oddity of the system they accept without much thought. But for the 32% of Australians who delay or avoid dental care because of cost, this exclusion is not a bureaucratic footnote. It is the reason infections worsen into emergencies, the reason people show up to hospital emergency departments for tooth pain, and the reason over $7.6 billion was paid out-of-pocket by Australians for dental care in 2022–23 alone.

Understanding why dental is excluded from Medicare requires going back to 1975. Understanding what it costs requires looking at today.

The Gap: What Medicare Covers, and What It Does Not

Medicare is built on the principle that essential health care should be available to all Australians regardless of their ability to pay. It covers GP visits, specialist consultations, most diagnostic imaging, and a wide range of surgical procedures performed in hospitals.

The mouth is excluded.

Not partially covered. Not means-tested. Excluded — as a matter of founding policy that has never been reversed.

An Australian with a fractured hip receives publicly funded surgery. An Australian with a fractured tooth receives a private bill or, if they are lucky, a spot on a public dental waiting list that may stretch years into the future. The inequality is not subtle, and it is not accidental.

Over 85% of dental care in Australia is privately funded, according to the Australian Institute of Health and Welfare (AIHW). That figure — the highest among comparable OECD nations — reflects a system that has offloaded one of the most prevalent categories of disease entirely onto individual patients.

How It Happened: The 1975 Decision and What Followed

The story begins with Gough Whitlam’s Medibank — the precursor to Medicare — which was introduced in 1975 after years of political effort to establish a universal health insurance scheme for Australia.

In designing Medibank, the Whitlam government faced a fundamental tension: how to create a financially sustainable universal scheme while managing the opposition of medical professionals who feared fee controls. The bargain struck with the medical profession largely excluded dentistry from the equation. Dental was classified as a private, elective service — a framing that has echoed through every subsequent policy debate.

When the Fraser government abolished Medibank in 1981 and the Hawke government re-established it as Medicare in 1984, dental remained excluded. The political and fiscal logic was the same: universal dental coverage would have required a massive budget commitment and would have re-opened negotiations with dental professional bodies at a politically inconvenient time.

There was also a cultural assumption baked into the decision — that dental care was somehow less medically essential than care for other parts of the body. This assumption has since been comprehensively dismantled by medical research, but it shaped the 1975 and 1984 decisions in ways that persist today.

One Brief Exception

In 2007, the Howard government introduced the Medicare Chronic Disease Dental Scheme, which allowed GPs to refer patients with chronic conditions to dentists for Medicare-subsidised care. The scheme was well-intentioned but poorly designed — it was open to all income levels, was not means-tested, and rapidly exceeded its budget. The Gillard government abolished it in 2012, leaving a gap that has never been filled.

What the Exclusion Costs

The financial cost of dental exclusion is measurable. The health cost is harder to quantify but arguably more significant.

The Dollar Figures

Australians paid $7.6 billion out-of-pocket for dental services in 2022–23 — the largest single category of out-of-pocket health expenditure in Australia (AIHW). This figure dwarfs out-of-pocket spending on GP visits, specialist consultations, or pharmaceutical co-payments.

The burden is not evenly distributed. Higher-income Australians with private health insurance have dental extras cover that partially offsets their costs. Low-income Australians, who are least able to afford dental care and most likely to have untreated disease, bear the full cost or forgo treatment entirely.

Unmet Need and Deferred Treatment

The 2021 National Dental Telephone Interview Survey, conducted by the Australian Research Centre for Population Oral Health (ARCPOH) at the University of Adelaide, found that 32% of Australians avoided or delayed dental care due to cost. Among those without private insurance or access to public dental schemes, the rate was considerably higher.

The consequence of deferred dental care is not aesthetic. Untreated tooth decay progresses to pulp infection, abscess, and potentially systemic spread of infection. Untreated periodontal disease advances to bone loss and tooth loss. These are not minor conditions — they are serious infections that have documented links to cardiovascular disease, poorly controlled diabetes, and adverse pregnancy outcomes, including premature birth and low birth weight, via inflammatory pathways and bacterial translocation that research continues to characterise.

Hospital Emergency Presentations

When dental pain becomes unbearable and patients have no access to dental care, they present to hospital emergency departments — where dentistry cannot be performed and the patient typically receives pain relief and antibiotics before being discharged without treatment. The Australian Dental Association has repeatedly cited the burden of preventable dental emergency presentations on the hospital system as evidence that exclusion from Medicare is not a cost-saving measure but a cost-shifting one.

What Exists Now: The Patchwork of Public Support

The current system consists of several targeted programs that together cover a small fraction of the unmet need.

Child Dental Benefits Schedule (CDBS)

The CDBS provides eligible children aged 2–17 with access to up to $1,095 AUD in dental benefits over a two-year period. Eligibility is linked to family eligibility for certain government payments, including Family Tax Benefit Part A. The benefit covers basic services: examinations, X-rays, cleaning, fissure sealing, fillings, root canals, and extractions. It does not cover orthodontics or cosmetic procedures.

The CDBS is the most significant Commonwealth dental program currently operating, and it has increased access for a substantial number of children. However, $1,095 over two years does not cover the cost of moderate dental disease in a child who has not had regular care, and the program excludes adults entirely.

State and Territory Public Dental Schemes

All states and territories operate public dental clinics offering subsidised or free care for concession card holders, low-income adults, and those with specific health conditions. The quality of these services varies by jurisdiction, but the common feature is waiting lists — often 1–3 years for non-emergency care in many states. Emergency care is generally available more quickly, but emergency treatment addresses acute pain rather than underlying disease.

DVA Dental Coverage

The Department of Veterans’ Affairs (DVA) provides eligible veterans with access to dental services, including general dental care, dentures, and some specialist procedures. DVA dental coverage is among the most comprehensive publicly funded dental programs in Australia and is often cited as a model for what broader coverage could look like.

Concession Card Holders

Beyond the CDBS and state schemes, holders of the Commonwealth Seniors Health Card and Pensioner Concession Card may access reduced-fee or bulk-billed services at some practices, depending on the state and the individual practice’s policies. This is not a universal entitlement — it depends on the discretion of individual dentists and the availability of bulk billing in the dental sector.

How Australia Compares Internationally

Australia is frequently described as the only OECD country without universal or near-universal dental coverage — a characterisation that requires some nuance but reflects a genuine outlier status.

United Kingdom: NHS dental care is subsidised for all UK residents under a three-band charge system. As of 2026, NHS dental charges are capped at approximately £306 for the most complex treatment (Band 3). This is not free, and NHS dental access has become increasingly difficult to obtain in some regions, but the subsidy principle is universal.

New Zealand: Publicly funded dental care is available for all New Zealanders under 18 through the Community Oral Health Service. Adults receive no such entitlement, making New Zealand’s system — in coverage terms — closer to Australia’s than to the UK’s.

Canada: Dental coverage varies by province and has historically been largely private. The Canadian federal government introduced the Canadian Dental Care Plan in 2023, aiming to provide coverage for uninsured Canadians with household incomes below $90,000 CAD — a significant expansion that reflects growing international consensus that dental exclusion is a systemic failure.

Germany, France, the Netherlands: All provide some level of statutory dental coverage for adults, typically covering preventive care and basic restorative treatment with patient co-payments for more complex procedures.

Australia’s combination of near-total Commonwealth exclusion and a public system that covers only a fraction of the low-income population is unusual among wealthy liberal democracies.

What Reform Would Look Like

The ADA and ACOSS have both argued for phased Medicare dental expansion, and their proposed approach is pragmatic rather than maximalist. Rather than immediately extending Medicare to all adults for all dental services — a measure that would cost tens of billions of dollars annually — the reform case focuses on two priority groups:

Low-income adults: People who cannot afford private care and whose public system access is limited by waiting times. A means-tested Medicare dental benefit for this group would address the most acute unmet need at a fraction of the cost of universal coverage.

People with chronic disease: Individuals with conditions such as diabetes, cardiovascular disease, and immunosuppression, for whom untreated oral disease has direct and documented health consequences. Covering basic dental care for this group represents preventive medicine with clear downstream cost savings in hospital and specialist care.

This targeted approach was the basis of the abolished 2007 Chronic Disease Dental Scheme — the failure of which was a design failure (no means-testing, no cost controls), not a failure of the underlying principle.

Modelling by health economics researchers has suggested that targeted dental Medicare for concession card holders could be implemented for approximately $2.4–$4.5 billion per year — significant, but comparable in scale to other Medicare expansions, and potentially offset by reductions in emergency hospital presentations and chronic disease complications.

What You Can Do Now

While systemic reform remains a matter of political will rather than imminent policy, there are practical steps available to Australians navigating the current system:

Check your eligibility for existing programs. If you have children aged 2–17, check whether your family qualifies for the CDBS via Services Australia. If you hold a concession card, contact your state or territory health department about public dental eligibility and waiting times — enrolling now, even with a long wait, is better than enrolling later.

Use private health insurance strategically. Basic dental extras cover — typically $300–$600 in annual dental benefits — is available in the lower tiers of many private health funds and may cost less per year than a single dental visit. Run the numbers for your situation.

Prioritise preventive care. The cost of a twice-yearly checkup and clean is significantly lower than the cost of treating the decay, gum disease, or infections that preventive care catches early. Cost-conscious delay is often more expensive in the long run.

Contact your federal MP. The ADA has an active advocacy campaign for dental Medicare expansion. Adding your voice — a constituent, a voter, a patient who has deferred treatment due to cost — to that correspondence has more impact than it might seem.

Talk to your dentist about payment options. Many dental practices, including Townsville Dental Clinic, offer payment plans, phased treatment to spread costs over time, and itemised quotes that let you prioritise the most urgent work.

At Townsville Dental Clinic, we understand that cost is a real barrier for many of our patients. We offer transparent pricing, payment plans, and CDBS billing for eligible children. If you are concerned about the cost of dental care, contact us to discuss your situation — we would rather help you find a way to access care than see you defer treatment to the point of crisis.

This article is intended as a general information guide and does not constitute legal, financial, or dental advice. Government program details and eligibility criteria are subject to change; verify current details with Services Australia or your state health department.