Medicare

Medicare and Dental Care at Dental Nook

Medicare is the foundation of Australia’s public health system. It helps many families manage the cost of medical care, especially those on lower incomes.

For dentistry, the picture is different. Medicare support is limited and is mainly focused on children through the Child Dental Benefits Schedule, often called CDBS. Adults usually need private health cover or self-funded care.

At Dental Nook Brisbane, we want families to clearly understand what Medicare can and cannot pay for, and how we can help you make the most of any benefits that are available.

What is the Child Dental Benefits Schedule?

The Child Dental Benefits Schedule is a government-funded program that sits under Medicare. It is designed to help eligible children and teenagers from 2 to 17 years old access essential dental care.

Eligible children receive a benefits cap of up to one thousand dollars over two years. This amount is set by the Australian Government and may change from time to time. The benefit can only be used for approved dental services and only at practices that accept CDBS.

The aim is simple. Support families so children can receive regular dental care, prevent small problems from becoming big ones, and grow up with healthy smiles.

Who is eligible for CDBS?

To receive CDBS benefits, a child must

Be aged between 2 and 17 for at least one day in the calendar year
Have a Medicare card
Be part of a family that receives certain government payments, such as Family Tax Benefit Part A, or specific allowances and pensions

Eligibility is assessed by Services Australia each year. If your child is eligible, the government usually sends a letter, text message, or email at the start of the year.

If you are not sure whether your child qualifies, our reception team at Dental Nook can check eligibility directly with Medicare before treatment begins.

What dental services are covered under CDBS?

CDBS is designed to cover basic and preventive dental care. At Dental Nook, these services may include

Routine check-ups and examinations
Scale and polish cleaning
Fluoride treatments
Dental X-rays
Fissure sealants
Fillings
Simple extractions
Root canal treatment for baby or adult teeth if clinically required

To be claimable, the treatment must be clinically necessary. This means your dentist decides that the service is needed to diagnose, prevent, or treat a dental condition, not just improve appearance.

Some limits also apply. For example

Only one filling can be claimed per tooth per day
Sedation may be available only a limited number of times in a set period, and usually only with specific agents allowed under the scheme
Treatment can only be claimed up to the current two-year benefit cap

Before any care begins, we will discuss the recommended treatment plan, explain which items are covered by CDBS, and let you know if any fees may sit outside the program.

What is not covered by CDBS?

The Child Dental Benefits Schedule does not cover every possible dental service. In general, it does not include

Orthodontic treatment, such as braces or clear aligners
Cosmetic procedures that are done purely to improve appearance
Complex surgical procedures that fall outside the listed item numbers
Treatment that is not considered clinically necessary

If your child requires care that is not eligible under CDBS, we will give you clear information about the options, costs, and any possible private health fund rebates.

How Dental Nook uses CDBS?

Our goal is to make CDBS as easy as possible for families.

We can check your child’s eligibility with Medicare before the appointment
We bulk bill eligible CDBS services whenever possible, so there is no gap to pay up to the available benefit
If a service is partially covered or not covered, we will explain this in advance and provide an estimate

On the day of the visit, you simply bring your Medicare card, and a parent or guardian signs a consent form for the treatment and the claim.

If you prefer not to use bulk billing, you can pay in full at the practice and claim your rebate from Medicare directly.

What happens when my child turns 18 or is newly eligible?

If your child turns 18 during the year, they can still use CDBS for that calendar year as long as they met the age and eligibility criteria on at least one day
A child who turns 2 during the year can start using the benefit from the time they become eligible

Any unused balance within the two years stays linked to your child, as long as they continue to meet the government eligibility rules.

Medicare and dental care for adults

Medicare does not include a general dental program for adults in private practices. This means

are usually funded either out of pocket or through private health insurance with extra dental cover.

There are some public dental services for adults through Queensland Health, generally for holders of specific concession cards. Waiting lists and eligibility rules apply and these services are not provided through Dental Nook.

Private health insurance and payment options

Because Medicare support is limited for adults, many patients choose a private health fund with extras cover. Depending on the level of cover, this may help with the cost of

Preventive care, such as examinations and cleaning
Restorative treatment, such as fillings and extractions
Major dental treatment, such as crowns, bridges, and dentures
Orthodontic treatment, such as braces or clear aligners in some policies

Each fund and policy is different. The rebate you receive can depend on factors such as waiting periods, annual limits, and whether the dentist is a preferred provider. Our front desk team can help you claim on the spot with HICAPS for most major health funds.

If you do not have private health insurance, we can discuss other options to make treatment more manageable, such as staged treatment plans and flexible scheduling of visits.

Common questions about Medicare and dental care

Do I need a referral to use CDBS at Dental Nook?

No referral is required. If your child is eligible, you can book directly with us. We will confirm the CDBS status with Medicare before treatment.

Can I choose how I use my child's CDBS balance?

Yes. The balance can be used across multiple visits over the two years as long as the services are included under CDBS and are clinically necessary. We will help you plan care so that you use the benefits in a sensible and effective way.

What happens when the benefit cap is reached?

Once the two-year cap is fully used, any further treatment for that period becomes privately funded or may be partly covered by your health fund if you have extras cover. When a new two-year period starts, a fresh cap is usually applied if your child remains eligible under Medicare rules.

Can CDBS be used for emergency dental care?

Yes. If your child has toothache, infection, dental trauma, or another urgent problem, many emergency treatments can be claimed under CDBS. Call our team, and we will guide you through the next steps and confirm eligibility as quickly as possible.

How Dental Nook can help your family?

At Dental Nook Brisbane, we believe every child and every adult deserves access to quality dental care with clear and transparent costs.

For children, we help you understand and use the Child Dental Benefits Schedule so you do not miss out on government support that you are entitled to
For adults, we provide detailed treatment plans, item numbers for health fund claims, and clear explanations of fees before treatment starts
For families, we aim to schedule visits in a way that fits school and work commitments while keeping regular care on track

If you would like to check your child’s CDBS eligibility or talk through payment options for adult treatment, our team is always happy to help.

Book a Medicare or CDBS visit at Dental Nook

If your child may be eligible for the Child Dental Benefits Schedule, or if you simply want to understand how Medicare and private health insurance apply to your family, contact Dental Nook today.

Our friendly team can

Confirm CDBS eligibility
Explain what services can be bulk billed
Arrange check-ups and treatment for children and adults

Caring for your family’s oral health starts with understanding your options. We are here to guide you every step of the way.