I just read a great article by the ABC about their experience with dental cover in Australia. It’s a funny industry, dentistry. Whilst we obviously accept private health insurance, we have noticed that the difference between naturally rising costs (inflation, CPI etc) and the rebates our patients receive, have started diverging, despite insurance premiums rising steadily.
The toothache story that many of us can relate to
Here’s how it often goes: you wake one day with a dull ache, you realise the problem is serious, you seek out a specialist (in this case an endodontist) and you brace for the financial hit. In the article, the writer of the article paid $360 for the first appointment (including a scan) and — despite decades of paying premiums — received a payout of only $25 from their insurance provider. (ABC)
Think about that: thousands of dollars in premiums over years, and at the moment you need “extras” cover (such as dental work) you get crumbs. It’s no wonder that the writer says they “realised I'd been duped”. (ABC)
If you hold private health insurance hoping it will relieve your dental-care burden, you may be in for a surprise. Your dentist might be working hard, but the insurance layer around it often falls short.
Professional bodies such as the Australian Dental Association (ADA) have openly suggested that many consumers would be better off “putting the money aside for potential dental work” rather than handing it off to a health insurer and hoping for a useful rebate. SBS Australia
What the numbers tell us
Industry data show that the average premium increase for private health insurance in Australia is around 3.73 % in 2025. Private Healthcare Australia (PHA)+2Money.com.au+2
By contrast, although detailed dental-rebate amounts aren’t always published separately, the broader picture of dental services shows that in 2022-23 Australians spent about $12.5 billion on dental services — with individuals spending over $7.6 billion of that themselves. aph.gov.au+1
Meanwhile, despite more people holding “general treatment/extras” cover (55.1 % of the population had some general treatment cover by June 2025) apra.gov.au+1 the amount paid in benefits for those general (ancillary) services fell by 4.3 % in that quarter. apra.gov.au
In short: you’re paying more in premiums, but the payout for extras (which includes dental) is either not growing or may even be shrinking (in some measures).
Why the insurance model struggles (especially for dental)
Dental treatment sits awkwardly between “routine maintenance” and “major intervention” and many dental cover features (in extras policies) carry waiting periods, annual limits, exclusions, or low benefit caps. Compare the Market
Because premiums rise steadily (often faster than wage growth or inflation) while benefits for extras haven’t kept pace, the value proposition weakens.
A dental specialist appointment (and follow-up treatment) often involves high out-of-pocket costs — and if the insurer rebate is trivial, then you’re still shouldering most (or all) of the cost.
The dentist is providing the care, incurring overheads, training, equipment costs — but the insurer is simply making a rebate that may bear little relation to real cost burdens.
A word of credit for dentists
In this context, it’s worth recognising the work that dentists do under strained conditions. Patients often present in pain or anxiety, need complex diagnostics, treatment planning, follow-through and sometimes significant restorative work. Good dentists are committed to care, clear explanations, and managing your oral health — often quietly compensating for system shortfalls. In fact, a recent study this year, through the University of Melbourne showed that, in the last decade, the cost of dental care has risen at less than the pace of inflation and wage rises - essentially, dentistry is cheaper now, in real terms, than 10 years ago, and dentists are taking a hit, to help their patients (the same cannot be said for private health insurers).
What you as a patient can do
Read your policy fine print: Know exactly what your extras cover allows — what dental items are eligible, what the waiting periods are, what the maximum benefit is, and what kinds of treatments are excluded or limited.
Ask your dentist for a realistic quote, and then ask your insurer what rebate you’ll actually receive for that treatment plan. Don’t assume “I have cover → I’ll get mostly reimbursed”.
Think in parallel savings terms: If, as some dentists suggest, you might be “better off putting the money aside for treatment” instead of heavy premium payments, then consider budgeting for dental care directly (e.g., a dedicated savings account).
Maintain preventive care: Regular check-ups, hygiene, early intervention cost less and avoid costly specialist treatment down the track — and these are areas where dentists can significantly add value.
Consider your wider strategy: If you find that your extras rebate is negligible relative to treatment cost, then evaluate whether a lower-cover policy plus self-savings makes better sense. You may still retain hospital cover for major events but treat extras separately.
Conclusion
The bottom line: You deserve a dentist you can trust — someone who will do the work, guide the treatment, manage the discomfort and give you options. But when it comes to private health insurance covering dental care, the picture is less reliable. Premiums keep rising; the rebate for extras may not keep up; and when you need real dental work, you might find yourself paying nearly the full cost anyway.
