"Can I claim this on Medicare?" If we had a dollar for every time our reception team heard that question, well, it might help cover a few check-ups.
For most adults, the honest answer is no. Medicare covers very little general dental treatment for adults in Australia. But there are some important exceptions, especially for children, and knowing about them could save your family real money.
Let us break down what Medicare does and does not cover, how the Child Dental Benefits Schedule works in 2026, and what your other options are in Newcastle.
What Medicare Does Not Cover
Medicare is Australia's universal scheme for medical services such as GP visits and many hospital services. Dental care has historically been funded separately. So Medicare does not generally pay for routine adult dental care, including:
- Check-ups and examinations
- Scale and clean appointments
- Fillings
- Root canal treatment
- Crowns, bridges and veneers
- Dentures and dental implants
- Teeth whitening and other cosmetic treatment
Most adults pay privately, often with help from private health insurance extras.
What Medicare Does Cover
There are three main areas where Medicare-funded dental benefits apply.
1. The Child Dental Benefits Schedule (CDBS)
This is the big one for families. According to Services Australia, the CDBS covers basic dental services for eligible children aged 0 to 17.
How much? Up to $1,158 per eligible child over two consecutive calendar years, for treatment periods starting in 2026. The cap is indexed every 1 January, and any amount not used in the first year carries into the second, as long as the child remains eligible.
What is included? Examinations, X-rays, cleaning, fissure sealants, fillings, root canals, extractions and partial dentures.
What is not? Orthodontic treatment, cosmetic work, and dental services in hospital.
Who is eligible? Generally, children whose parent or carer receives Family Tax Benefit Part A or another relevant Australian Government payment. The Department of Health's CDBS guide sets out the full rules.
Illustrative example
The benefit sitting unused
Consider a Fletcher family with two children who are both eligible for the CDBS. The parents assume "dental is never covered", so they have been paying out of pocket for check-ups. After a quick eligibility check at reception, they learn both children can be seen under the scheme at no cost to them for eligible services, within the cap.
It is a common situation. If you receive Family Tax Benefit Part A, it is always worth asking.
At MS Dental, we provide child dental bulk billing for eligible children at Cardiff, Fletcher and Mayfield. See our children's dentistry page for how we care for young patients, and our blog on when kids should see a dentist.
2. Cleft and Craniofacial Conditions
Medicare provides benefits for certain dental and oral surgery services for people with eligible cleft and craniofacial conditions, such as cleft lip and palate. Some items need a referral, so confirm with your practitioner before treatment begins.
3. Some Hospital-Based Treatment
If you are admitted to a public hospital for a serious dental or oral condition, that hospital treatment may be covered as a public patient. This does not extend to routine care at a private practice.
How to Use the CDBS at a Private Clinic
Many families do not realise they can use the CDBS at participating private practices. Here is how it usually works:
- Check eligibility through your Medicare online account, or ask our reception team to check for you.
- Mention the CDBS when booking so we can confirm eligibility before the visit.
- Bring your Medicare card, with the child listed on it.
- Sign the consent form before treatment.
- Ask about the plan. If more treatment is needed, ask whether it is covered and how much of the cap it will use.
Public Dental: The State-Funded Safety Net
Separate from Medicare, each state runs a public dental service. In NSW, eligible adults with a Health Care Card, Pensioner Concession Card or Commonwealth Seniors Health Card can access free care at public clinics. Children are also eligible. Because demand is high, patients are triaged by urgency, and non-urgent waits can be long.
For more local options, read Can't Afford a Dentist? Affordable Dental Care Options in Newcastle.
If Medicare Does Not Cover You
Do not lose heart. You still have options:
- Private health insurance extras. General dental cover usually contributes to check-ups, cleans, X-rays and fillings. See our preferred provider information and our guide to making the most of your private health insurance.
- Payment plans. Explore our payment plans or read our guide to dental payment plans in Newcastle.
- Prevention. Regular check-ups and cleans can help catch problems while they are small. More in How to Avoid Expensive Dental Treatments Through Preventive Care.
Why Is Dental Not in Medicare?
It is a long-running public policy debate. Dental was not included when Medicare began, and adding it would carry a large cost to government. Groups including the Australian Dental Association continue to call for better funding, particularly for seniors and people on low incomes. For more on the costs involved, see Why Is Dental Care So Expensive in Australia?
How MS Dental Can Help
Navigating Medicare, health funds and government programs can feel like a maze. Our team can:
- Check your child's CDBS eligibility and remaining balance before treatment
- Bulk bill eligible CDBS services, so there is no out-of-pocket cost within the cap
- Provide item numbers for health fund claims
- Explain your payment options for treatment Medicare does not cover
Common Medicare and Dental Myths
- "Medicare covers dental for everyone under 18." Not quite. The CDBS is means-tested, so eligibility depends on government payments your family receives.
- "Bulk billing means everything is free." Bulk billing covers eligible CDBS services within the cap. Anything outside the scheme, such as orthodontics, is charged separately.
- "Public dental is only for emergencies." NSW public dental also provides general care for eligible adults and children, although waiting lists apply.
Frequently Asked Questions
Can I use my Medicare card at the dentist?
For eligible children under the CDBS and certain eligible conditions, yes. For routine adult care, Medicare does not provide a rebate.
Does the CDBS cover braces?
No. Orthodontic treatment is excluded.
Can my 17-year-old still use the CDBS?
Yes, if they are eligible. Eligibility generally lasts for the whole calendar year in which they are 17 for at least one day, so check their remaining balance before 31 December of the year they turn 18 so benefits are not missed.
Is a dental emergency covered by Medicare?
For adults, generally not, unless you are admitted to a public hospital. For eligible children, urgent basic treatment such as an extraction may be covered under the CDBS within the cap. MS Dental provides emergency dental care across our Newcastle clinics.
Not Sure What You Are Covered For? Ask Us
We are happy to check your child's CDBS eligibility and explain your options before any treatment begins. It only takes a quick call or a few minutes online.
Refer a friend to MS Dental and you could both receive a 10% discount on your next appointment (minimum spend $300, discount capped at $50, one discount per patient, the new patient redeems their referral card first, and it cannot be combined with other offers). Full terms and conditions.
Program amounts and eligibility are set by the Australian Government and may change. Figures are current as of October 2026. Please confirm details with Services Australia.