Dental insurance is a form of private insurance that focuses on preventative and restorative care.
Generally, this includes treatments that benefit your oral well-being and your long-term dental health.
Policies cater to anyone who does not have group dental coverage through their work as well as anyone who is self-employed, freelancing, doing contract work, or retired.
What Does Common Dental Insurance Cover?
Dental policies vary greatly between insurers.
However, most policies include procedures such as checkups, x-rays, fillings, root canals, crowns, and oral surgery such as tooth extractions.
They may also include some coverage for emergency treatments.
Depending on your policy, it may also cover periodontal treatments for the structure that surrounds and supports your teeth such as your gums.
Some also cover orthodontic treatments for a mal-positioned jaw, misaligned bite, or poorly positioned teeth.
This may include the use of devices such as braces and retainers.
Finally, your policy may include prosthodontics such as dentures and bridges.
Policies that include periodontic and prosthodontic treatments may include a one-year waiting period before you can access care.
Orthodontic care may require a rider on your dental policy and an additional fee.
Like all insurance policies, dental policies usually include a deductible and limits.
This may include an overall policy limit, specific limits for each procedure, and sometimes a lifetime limit on major costs such as orthodontics.
As an example, your policy may allow two checkups each plan year.
It may also limit the amount the policy will cover for cleanings, x-rays, fillings, and root canals within the policy’s year.
If you surpass these limits, you’ll pay the difference out of pocket.
Most dental policies also exclude experimental treatments and services or those performed by someone other than a dental professional.
However, other exclusions are less obvious so it is important you read the fine print.
As an example, some dental policies don’t cover dental sealants.
Generally, dental policies exclude any “cosmetic” procedure that doesn’t benefit your long-term oral health.
For instance, a dental implant would be considered elective and probably wouldn’t be covered under your dental policy.
Other common exclusions are dental veneers and whitening.
How Does Dental Insurance Work?
Every policy outlines how much it covers for a group of procedures.
A common coverage structure is an 80/20 co-payment for preventative care such as checkups and cleaning.
In this case, your policy pays 80 percent and you pay 20 percent out of pocket.
However, your policy will probably have a different coverage structure for major procedures such as crowns and bridges.
Many dental policies have a 50/50 co-payment structure.
Your policy pays 50 percent and you pay the remaining 50 percent.
How dental professionals handle billing may differ between offices.
Some directly bill your insurer and then the insurer sends them an invoice outlining what they’ll cover and what you need to pay.
However, some offices won’t bill directly.
Instead, they issue you an invoice and you have to pay it upfront.
Then you submit the invoice to your insurance company and wait for reimbursement.
Insurers offer many policies with many variables.
As a result, it is very important you understand precisely what each policy offers, so you can choose the benefits you need and compare prices accordingly.
Good dental coverage is about finding the best possible coverage at the most reasonable cost.
Is Dental Insurance Worth It?
Considering the cost of dental care in Canada, it can often save you money.
Even though you will pay premiums, co-payments, and a deductible, these costs can amount to far less than just a single visit to the dentist.
As an example, the 2021 Ontario Dental Association fee guide suggests the cost of a root canal is between $562 to $710.
A crown ranges between $900 and $1200, or more.
While the Canadian Dental Association estimates the average spend for Canadians is $378.60 annually, this belies the fact that many simply don’t go to dental professionals due to cost.
A 2018 StatsCan report found one in five Canadians avoid visiting a dental professional because it is too expensive.
One thing is certain – dental care isn’t getting any cheaper.
Regrettably, ignoring small problems today can easily create big, expensive problems in the future that you can’t ignore.
When considering whether dental insurance is worth it, price shouldn’t be the only factor.
Regular oral health care also improves overall health.
What Can I Expect to Pay for Dental Insurance?
You will pay several costs for dental insurance.
These could include:
Premiums – the monthly or yearly amounts you pay for your chosen coverages.
Deductible – the amount you pay before your insurance kicks in.
Choose the highest deductible you can comfortably afford to reduce your premiums.
Some policies do not include a deductible.
Co-payment – the portion of your dental bill you pay out of pocket based on the percentages outlined in your policy.
Rider – extra charge for additional coverage on your policy.
A bare bones policy may cost as little a $40 per month for a single individual.
However, you can also buy more expensive policies which include extended healthcare coverage, vision care, travel, prescription drugs, and more.
You may enjoy lower prices if you buy as a couple or a family.
Discounts and specialty policies are often available for seniors and students too.
Frequently Asked Questions
- Does health insurance cover dental in Canada?
The Canada Health Act does not extend to dental care. However, some provinces and territories offer some dental coverage for children. They also provide medically necessary care to various marginalized groups.
- Does Canada have dental insurance?
No. Generally, Canadians finance their own oral care through employment-related dental coverage, private dental insurance, or by paying out of pocket.
However, the federal government does cover some or all oral health care costs for some individuals. These include refugees, veterans, and qualifying Indigenous peoples.