Medicare does not currently cover the cost of dentures. This is despite the best efforts of some non-governing political parties and peak bodies like Consumers Health Forum of Australia, the Australian Dental Association and the Grattan Institute who have lobbied the federal government for publicly funded dental care. However, depending on the state or territory in which you live, dentures may be available for eligible adults through your state public health system.i
Who is eligible for public dental services including dentures?
To be eligible for dentures through the public health system, adults must have one of the following:
- Health Care card
- Centrelink Pensioner Concession Card
- Veteran Gold Card or
- Veteran White Card ii
Some Aboriginal Community Controlled Health Organisations (ACCHOs) also provide dental services for eligible patients. iii
Your eligibility for access to dentures through the public health service is assessed by dental staff in public dental clinics, usually located within your local public hospital. Your local Health District may then issue Oral Health Fee For Service Scheme (OHFFSS) vouchers and a list of providers for you to access dental services and dentures.iv However, the waiting period to be seen is long. See here for more about the scheme and the procedure for applying for Oral Health Fee For Service Scheme (OHFFSS) - Oral health (nsw.gov.au) v
For information on what your state or territory covers see links below. vi
- New South Wales: NSW Health
- Australian Capital Territory: ACT Health
- Northern Territory: Department of Health
- Queensland: Queensland Health
- South Australia: SA Health
- Victoria: Department of Health
- Western Australia: Dental Health Services
- Tasmania: Oral Health Services Tasmania
Dental services covered by Medicare in special circumstances
While Medicare does not cover routine services like oral exams, fillings or the provision of dentures, there are exceptions. In special circumstances, as an admitted inpatient or registered outpatient, and if the success of your medical treatment requires it, Medicare may cover a limited range of dental services. For example, when treating a mouth infection by extracting a tooth before you have chemotherapy for cancer, or dental treatment before undergoing major heart surgery.vii
Why should dental services and dentures be covered by Medicare?
There is a huge demand for dental services through the public system. Lack of timely dental treatment results in many eventually needing emergency care. This is reflected in the approximately 800,000 GP consultations and hospital admissions for dental conditions occurring each year.viii
The Australian Dental Association suggests that despite approximately 8 million Australians being eligible to benefit, the waiting period to be seen - as long as 2 years in some cases – means far fewer are attended to. According to The Australian Dental Association, while some 8 million Australians are eligible for these clinics, long waiting lists mean far fewer get treatment.ix
What does the future hold for dental health to be covered by Medicare?
Even without a crystal ball, we can safely predict a future with universal dental health cover will be costly, which tends to dilute political will. Peak bodies like the Gratton Institute, Australian Dental Association and the Consumers Health Forum of Australia have called for the expansion of publicly funded dental care. A report from the Grattan Institute (2019) estimates universal dental cover would cost in the vicinity of 5.6 billion dollars a year with some 2 million of the most disadvantaged Australians currently missing out.x
Why is dental health so important?
The consequences of poor oral health are far reaching. Oral health issues left untreated, contribute to a rise in chronic conditions like diabetes, cardiovascular disease, oral cancers, and lung conditions.xi Conditions that may have been avoidable with better oral health care, are putting a strain on the public purse by way of hospital admissions and ongoing care. It is disadvantaged Australians like the poor, First Nations People, the elderly and rural and remote residents that suffer most.
The hidden social cost of no universal dental health care scheme
Poor oral health care can lead to edentulism overtime. People without teeth and no dentures to replace them, have potentially compromised social interaction and lower self-esteem, not to mention diminished ability to enjoy their food. The Gratton Institute calls for future planning to expand the dental health work force, fund existing public dental schemes adequately, and gradually phase in a universal dental health scheme, beginning with the most disadvantaged. xii
Dental health and the elderly
The lack of a universal dental health scheme is compounded for older Australians, especially those in aged care facilities. Dr Hopcraft, the ADA (Australian Dental Association) Victorian branch chief executive, says oral problems in the elderly often go unnoticed because the associated pain is covered by medications for other issues. A key recommendation made by the 2021 Royal Commission into Aged Care, acknowledged the significance of oral health care for the elderly and recommended the establishment of a seniors’ dental benefits scheme to guarantee older Australians had access to dental care.xiii At this point while the Labor government acknowledges the need, no such scheme exists. However, the 2022-2023 budget detailed another year for public adult dental care funding, with a commitment from Labor’s Health and Ageing minister Mark Butler, to eventually expand Medicare services to include dental services. xiv
Where to turn when you urgently need dentures?
Do not despair if you are in urgent need of dentures but unable to access them through Medicare. For further information on how to access dentures, check out our article 'The cost of dentures for pensioners in Australia'.
Final word on dentures covered by Medicare
There is no doubt replacing missing teeth with dentures is beneficial to the edentulous patient on health and wellbeing levels, as well as having knock-on benefits for the wider Australian economy. While Medicare does not currently fund dentures except in special circumstances, there are long term plans by the current Labor government to rectify this situation. State governments provide some dental health care, including dentures, through the public hospital system to eligible adults although waiting lists are lengthy.
References
i https://www.healthdirect.gov.au/cost-of-dental-care
ii https://www.dva.gov.au/get-support/health-support/health-services/dental-
care/dental-services
iii https://www.healthdirect.gov.au/cost-of-dental-care
iv Oral Health Fee For Service Scheme (OHFFSS) - Oral health (nsw.gov.au)
v Oral Health Fee For Service Scheme (OHFFSS) - Oral health (nsw.gov.au)
vi https://www.healthdirect.gov.au/cost-of-dental-care
vii https://www.medicare.gov/coverage/dental-services
viii https://www.abc.net.au/news/2022-04-27/why-is-dental-separate-from-
medicare-election-
campaign/101005940?utm_campaign=abc_news_web&utm_content=link&ut
m_medium=content_shared&utm_source=abc_news_web
ix https://www.abc.net.au/news/2020-03-18/dental-divide-leaves-poorer-
australians-unable-to-
chew/12064410?utm_campaign=abc_news_web&utm_content=link&utm_me
dium=content_shared&utm_source=abc_news_web
x Filling the gap: A universal dental care scheme for Australia - Grattan Institute
xi Filling the gap: A universal dental care scheme for Australia - Grattan
Institute
Disclaimer – Always consult your oral health professional for expert advice about your unique personal situation. The information given here is of a general nature and for the purpose of education only. It is not meant to replace the advice of your oral health specialist
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