Do you need health insurance for wisdom teeth?

Wisdom teeth extraction is not generally covered by Medicare and can cost hundreds of dollars. Here is how private health cover helps with costs.

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by Gary Andrews

Last update 15 Apr 2021

Overview

Dental bills can sometimes be more painful than the visits themselves, especially when it comes to extracting wisdom teeth, as the costs aren't usually covered by Medicare.

But if you have the right health insurance, you can help protect your teeth as well as your wallet.

This guide will cover all you need to know about wisdom teeth extraction and what type of health insurance can help reduce your bill.

Key Points

Wisdom tooth extraction can cost hundreds or even thousands of dollars.
Extras policies can cover simple extractions while hospital cover includes more complex dental surgery.
Waiting periods for wisdom teeth extraction are usually 12 months.
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Are wisdom teeth covered by health insurance?

In most cases, yes.

But it really depends on what policy you have.

Most health insurers will cover some or all of the cost of wisdom tooth extraction under their extras policies.

However, this is only for 'in-the-chair' procedures at a dentist's clinic.

If you need a more complex extraction under general anaesthetic, say for an impacted tooth, it's more likely you'll need to have dental surgery in hospital.

In that case, only a combined hospital and extras policy will help cover some or all of your costs.

Can I get my wisdom teeth out through Medicare?

The short answer here is probably not.

Medicare doesn't offer cover for wisdom teeth removal for the majority of Australians.

There are some exceptions, but they vary from state-to-state -- the government's Health Direct website is a good place to check if you're covered.

There's often a long waiting list of up to two years for dental treatment in a public hospital if you're not considered an emergency.

How do I know if I need my wisdom teeth removed?

As wisdom teeth start to emerge, they put lots of pressure on other teeth, which can cause extreme pain.

This tends to be one of the main signs that you need them removed.

Another thing to look out for is decay or infection around an impacted wisdom tooth, which is when the tooth is only partially emerged from the gum.

As long as you visit your dentist for regular check-ups, they'll probably flag if your wisdom teeth are likely to be an issue in the future.

Are wisdom teeth classified as a pre-existing condition?

Yes. Wisdom teeth are usually classified by insurers as a pre-existing condition.

Most pre-existing conditions come with a 12 month waiting period before you can claim on them.

What are the waiting periods like for wisdom teeth?

Most insurers will have 12 month waiting periods for major dental treatments such as wisdom tooth extractions.

From time-to-time insurers do run offers that cut or waive some waiting periods, so it's worth keeping an eye out for this.

Our team of specialists can help here, as they're fully up to date with any offers and discounts from insurers on our panel.

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How much will extraction cost me?

Your costs will depend on whether your extraction is completed in the chair by a dentist or if you're admitted to hospital as an in-patient.

Without private health cover

Simple in-the-chair extractions generally cost anywhere between $150 and $200 per tooth.

If you need a local anaesthetic but the procedure can still be done in the chair, this could rise as high as $400 per tooth.

If you need to be given sedatives or general anaesthesia in hospital, the cost of an extraction could be thousands of dollars per tooth.

These costs don't include initial consultations and any x-rays, so you could be significantly out of pocket if you don't have appropriate health insurance.

With private health cover

It's common for extras to cover 60% or 75% of the above costs, although some funds offer up to 100% for in-the-chair procedures.

It's a bit more complicated with hospital extractions.

Your extras cover will cover some or all of the cost of the dentist or dental surgeon fees, while an appropriate hospital policy covers the cost of theatre, accomodation and anaesthetist fees.

But if your anaesthetist charges above the Medicare Benefits Schedule Fee, you'll need to pay a 'gap' or out-of-pocket fee, so it's always worth checking the costs before you book yourself in for surgery.

How much will health insurance cost me for wisdom teeth removal?

It really depends on your policy.

Some health insurers offer higher dental claim limits but more expensive premiums, while others let you claim lesser amounts and have cheaper premiums.

It's also worth checking if an insurer has a no or known gap fee scheme on their hospital cover, so you're not hit with unexpected out-of-pocket expenses.

Put simply, when it comes to dental cover, there are a lot of different variations, from cost, to annual claim limits, to rebates, and the cheapest policy may not always be the best policy.

That's why it's important to compare policies to find one that suits your needs and budget.

The specialists at Compare Club can help.

We'll compare policies from our panel of trusted insurers to find one that's right for you.

What happens if I need to go to hospital for my wisdom teeth?

First of all, don't freak out.

The thought of being under the knife is usually worse than the procedure itself.

You'll be under general anaesthetic, so you won't feel a thing.

Before you're admitted to hospital, you should ask for an estimate of fees from your dentist or dental surgeon and make sure you understand the costs.

The quote -- officially known as informed financial consent -- will include the dental item numbers for your wisdom tooth extraction.

After you've done that, get in touch with your health fund to confirm your level of cover for the procedure, your hospital excess and any other costs.

Is it worth getting cover for my wisdom teeth?

If you're worried about your wisdom teeth, then you should definitely consider private health insurance.

As wisdom teeth aren't usually covered by Medicare, you're at risk of being hundreds or even thousands of dollars out of pocket if you need treatment and don't have an appropriate level of cover.

You'll need to consider if you'll need a hospital, extras or combined policy, but these will come with additional benefits and you'll be seen quickly at a private hospital -- no lengthy public hospital waiting lists for you.

It's not just wisdom teeth -- appropriate private health cover will cover you for a range of other treatments from physio and optical (extras) to rehabilitation and emergency ambulance (hospital cover).

Having appropriate private hospital cover may also help you avoid the Medicare Levy Surcharge at tax time.

Are there different types of dental insurance?

In Australia, there's no such thing as 'dental insurance'.

However, different levels of dental cover are included in most health insurance extras policies.

Extras cover is split into two categories: General Dental and Major Dental.

You'll usually be covered for wisdom tooth extraction through an extras policy that covers major dental services, although these policies won't cover hospital and anaesthetist fees.

All Hospital policies in the Silver tier and above must include cover for dental surgery (including wisdom tooth extraction), but some insurers may also include dental surgery in their Bronze policies.

Some even have a restricted level of cover in their Basic hospital policies.

To cover all your bases, your best bet is to take out a combined Extras and Hospital policy.

Where can I get the best health insurance for dental issues?

Different health insurers offer different levels of cover, and it can get pretty complex sifting through all your options.

Using Compare Club is a simple way to find a policy that's suited to you and your budget.

Our expert team compares across some of Australia's most trusted health insurers, so you can rest easy, knowing that you're in good hands.

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This guide is opinion only and should not be taken as medical or financial advice. Check with a financial professional before making any decisions.

References Australian Dental Association, [2019 fee survey](https://www.ada.org.au/Utility-Pages/Login?returnurl=%2fProfessional-Information%2fBenchmarking%2fDental-Fees) NSW Health, Dental Information For Patients Health Direct, Cost of Dental Care