Does Medicare cover dental? What it pays in 2026, and what it does not

Medicare is Australia’s public health scheme, and dental care has sat outside it since the start. The Parliamentary Library records that “Dental services were excluded from Medicare and its predecessor, Medibank, which commenced in 1975.” What Medicare does pay for teeth is narrow, and each piece of it has its own eligibility test. This page sets them out with the current figures.

Does Medicare cover dental for adults?

No, for almost all adults. The Department of Health, Disability and Ageing lists “most dental services” among the things Medicare does not cover. healthdirect, the government’s health information service, puts it the same way: “The Australian Government does not generally cover the costs of dental services.”

That means no Medicare benefit for an adult’s check-up, clean, filling, root canal, crown or denture at a private dentist in Australia, whatever the Medicare levy on your tax return. There are three exceptions, each covered below:

• children eligible for the Child Dental Benefits Schedule;
• people with an eligible cleft or craniofacial condition, under MBS Category 7;
• state public dental, which is not Medicare but is government-funded, for children and concession card holders.

What does the Child Dental Benefits Schedule cover in 2026?

The Child Dental Benefits Schedule (CDBS) is the one large Medicare dental program. Services Australia states: “We cover up to $1,158 for each eligible child over 2 calendar years for basic dental services under CDBS.” The Department’s CDBS Guide, version 14, effective 1 January 2026, applies that cap to two-year periods starting in 2026. The cap for 2025 was A$1,132, and “The cap amount is indexed yearly on 1 January.”

A child is eligible if they are eligible for Medicare, aged 0 to 17 for at least one day of the calendar year, and they or a parent receive an eligible payment such as Family Tax Benefit Part A at least once that year.

• Covered: check-ups, x-rays, cleaning, fissure sealing, fillings, root canals and extractions.
• Not covered: orthodontic work, cosmetic work and “any dental services in a hospital”.
• Use it or lose it: “If you don’t use the full amount within the 2 calendar years, you can’t use the remaining funds.”

The balance shows in a Medicare online account through myGov, and a dentist can check it at the appointment. In NSW, public dental clinics treat CDBS children “at no cost to you”. AIHW reports that in 2021 about 46% of children were eligible and just over a third of eligible children used it between 2018 and 2021. In 2025 the scheme paid A$352.2 million for 5.4 million services.

Can adults get free or cheap public dental?

Yes, if they hold a concession card. Each state runs its own scheme, funded by state and Commonwealth governments. These are the adult rules as each state publishes them, read 8 October 2026.

Victoria also treats all children aged 0 to 12, charging A$40 for a general course of care to a child without a card, and states that anyone assessed as unable to pay is exempt. NSW treats all children under 18 with a Medicare card free.

How long is the wait for public dental?

Long, for routine care. NSW Health sets a recommended maximum of 545 days for routine adult dental care and 1 day for emergency care. It reports that at 30 June 2026, 96% of people on its waitlist had been waiting less than the recommended maximum; its own statewide table gives 97%.

Victoria publishes an average wait of 14.7 months for general dental care and 7.7 months for specialist care, without naming the quarter the figures cover. Read 8 October 2026. Queensland describes starting general care “within two years of being placed on the list” as desirable. Nationally, the ABS found that 3.9% of Australians were placed on a public dental waiting list in 2024–25, against 4.0% in 2023–24.

When does Medicare pay for dental work?

Medicare pays dental items under MBS Category 7 for people with an eligible cleft or craniofacial condition, such as oral or facial clefting, congenital craniofacial malformations or hereditary missing permanent teeth. Services Australia notes that people treated before 1 November 2023 and aged 28 and over need approval. Three of the items, with fees updated 1 July 2026:

Fees and benefits from MBS Online, last verified 8 October 2026. Item 75400 applies only when an eligible oral and maxillofacial surgeon is treating a referred patient. A dentist may charge more than the schedule fee, and the difference is out of pocket.

Is dental surgery in hospital covered?

Under Medicare, only as part of public hospital care: the Department states that as a public patient Medicare subsidises “most surgeries and procedures”, with a possible wait for anything that is not an emergency. The CDBS itself excludes hospital dental services.

Under private hospital cover, dental surgery, defined by PrivateHealth.gov.au as “Hospital treatment for surgery to the teeth and gums”, with examples of “surgery to remove wisdom teeth, and dental implant surgery”, is a minimum requirement of Silver and Gold policies only. It is optional on Bronze and Basic. Gold, Silver, Bronze and Basic compared lists every category by tier.

Why is dental not covered by Medicare?

It never was. Dental care was left out of Medibank in 1975 and out of Medicare after it, and successive governments have funded it through separate programs instead. A Senate Select Committee established on 8 March 2023 delivered its final report in November 2023. Its Recommendation 35 asked the government to work toward universal access, including coverage “under Medicare or a similar scheme for essential oral health care, over time, in stages.”

The government’s response, dated July 2024, states: “The Government notes this recommendation.” The Parliamentary Library cites a Parliamentary Budget Office estimate that including dental in Medicare could cost A$45 billion over three years from 2025–26. As at 8 October 2026 no such scheme has been legislated.

Who pays for dental care in Australia, and who goes without?

Mostly patients. AIHW reports that A$13.2 billion was spent on dental services in 2023–24, and that “individuals directly fund a significant proportion of total expenditure on dental services, 61% in 2023–24”. Health funds paid A$2.6 billion, the Australian Government about A$1.5 billion and the states and territories A$1,058 million.

The cost shows up in who goes. The ABS found 16.1% of Australians delayed or did not see a dental professional because of cost in 2024–25, down from 17.6%, and 53.9% saw one at all. AIHW counts about 89,200 dental hospitalisations in 2024–25 that could potentially have been prevented, with the highest rate among children aged 5 to 9.

What does extras cover pay for dental?

Extras cover, or general treatment cover, is where most private dental benefit comes from. APRA’s June 2026 statistics, published 27 August 2026, show A$1,001.79 million paid in dental benefits in the June 2026 quarter, and A$283.51 paid per insured person in the year to June 2026, the largest of any extras category. At 30 June 2026, 55.5% of Australians held general treatment cover.

What a policy pays depends on its limits. The Department gives two typical shapes: “cover for 50% of the cost for each dental treatment” or “cover for up to $500 each year for dental treatments”. General dental usually carries a 2-month waiting period, which several funds were waiving for new members in October 2026, as set out in health insurance with no waiting period.

How dental extras differ on limits, sub-limits, preferred-provider gaps and waiting periods is laid out in dental cover compared.

Does Medicare cover dental for pensioners and veterans?

Pensioners: no. There is no Medicare dental scheme for older Australians. A Pensioner Concession Card opens state public dental, on the terms in the table above, and the Senate committee’s proposal for a Seniors Dental Benefit Scheme was noted by the government in July 2024, not adopted.

Veterans: the Department of Veterans’ Affairs pays for dental care for eligible card holders under its own schedule. Its April 2026 VetAffairs edition states that “From 1 January 2026 to 31 December 2027 your total limit is $5,980.30” for high-cost restorative items such as crowns and bridges, and that “The capped amounts apply even if you hold a Veteran Gold Card.”