Insurance change could push dental care further out of reach for seniors

More than half of Australians aged over 65 put off dental treatment last year, and cost was the main reason. Now dentists and seniors’ advocates are warning that a change to private health insurance could push care even further out of reach.

The Australian Dental Association NSW (ADA NSW) has raised concerns about the Private Health Insurance Amendment (Modernising the Private Health Insurance Rebate) Bill 2026. The bill would remove the higher age-based rebate currently available to eligible Australians aged 65 and over, and set rebate entitlements by income alone. For some older people, that means a lower rebate and a higher net premium.

ADA NSW President Dr Mark Morrin said the reforms aim to make the rebate more consistent across age groups, but their effect on access to dental care needs watching closely.

“If people respond to higher insurance costs by dropping extras cover, delaying treatment or turning to the public system, there could be consequences well beyond individual household budgets. While we don’t yet know how consumers will respond to these changes, which is precisely why monitoring their impact is so important,” Dr Morrin said.

The cost of a delay

Recent ADA research found 55% of Australians aged over 65 delayed dental treatment in the previous year, with affordability the primary reason.

The bills can be steep. In 2024-25, the median charge for a full crown was $1,684. The median private health insurance benefit covered $720 of that, leaving a median out-of-pocket cost of $1,000.

Private health insurance carries a large share of the country’s dental costs. Insurers paid around $2.5 billion in dental benefits in 2022-23, and dental made up about 13% of private health insurer spending.

“Older Australians are among the people who can least afford to delay essential dental care, yet we know affordability is already causing many to do exactly that,” Dr Morrin said. “If changes to the rebate mean some Australians over 65 years old face higher private health insurance premiums, we need to understand whether that leads people to downgrade or abandon their extras cover and what that ultimately means for their oral health.”

Who the change hits hardest

Seniors’ advocacy group COTA Australia says the burden falls heavily on people who can least carry it. It points to new Parliamentary Budget Office modelling showing that almost half of the $3 billion cut to the rebate would come directly from pensioners.

The modelling estimates around 1.5 million aged pensioners would be affected once the changes take effect from April 2027. Pensioners make up 42% of those affected, rising to 52% of the over-70s.

“The more we learn about these proposed changes, the more concerning they become, especially for people on fixed and low incomes,” COTA Australia Chief Executive Patricia Sparrow said. “This policy proposal needs a complete rethink.”

COTA’s own research found 82% of Australians opposed removing the higher rebate for people aged over 65, and more than 1 in 3 said they would consider downgrading or cancelling their cover if the changes went ahead. Its State of the Older Nation report found 1 in 4 older people are living in poverty.

“Many older Australians are already questioning whether they can continue to afford private health insurance,” Ms Sparrow said. “Making it more expensive risks pushing more people to downgrade their cover or leave the system altogether.”

Why teeth get harder to look after with age

Oral health tends to decline as we get older, which is why a new barrier to care matters. Australian Dental Association figures show 32% of people aged 55 to 74 have untreated tooth decay, along with 25% of those aged 75 and over. Gum disease is more common again: 51% of 55 to 74 year olds, and 69% of people aged 75 and over.

The effects add up over time. Around 46% of Australians aged 75 and over have fewer than 21 teeth, and untreated gum disease leaves 20% of that age group with no natural teeth at all.

Poor oral health rarely stays in the mouth. It makes eating and chewing harder, which feeds into poor nutrition and weight loss. It is associated with conditions such as diabetes and heart disease, and with a higher risk of chest infections in frail older people. It also carries a social cost, affecting speech, confidence and the simple pleasure of sharing a meal.

The picture is sharper in residential aged care, where about 190,000 older Australians live and daily oral care is often missed.

“Private health insurance doesn’t necessarily cover the full cost of dental treatment, but for many patients it makes a meaningful contribution towards that care,” Dr Morrin said. “That becomes particularly important as we get older because our oral health needs often become more complex.”

Pressure that flows through to the public system

Dr Morrin said dental extras cover can help with the cost of examinations, cleans, X-rays, fillings, root canals, extractions, gum treatment, dentures and other restorative work. When people drop that cover or delay treatment, more of them turn to public dental services that are already stretched. ADA NSW’s submission warns that lower use of private dental care could add to demand on public dental and hospital services in NSW.

COTA echoes that concern for the wider hospital system. “If these changes lead to people dropping or downgrading their cover, the consequences won’t just be felt by those individuals,” Ms Sparrow said. “There is a real risk of adding further pressure to an already stretched public hospital system.”

For most older Australians, general dental care is not covered by Medicare, so private cover is often the main way to manage these costs. That is the gap the two groups want the reform to avoid widening.

“The ADA NSW want to ensure a change designed to modernise private health insurance policy does not inadvertently create another barrier between older Australians and the dental care they need,” Dr Morrin said.