How to Choose the Right Private Dental Insurance Plan in Canada
What is private dental insurance?
Private dental insurance is a type of coverage you can purchase from an insurance company to help cover the cost of dental services. It’s separate from employer benefits or government programs, and it typically covers services such as:
- Dental check-ups
- Cleanings
- X-rays
- Fillings
- Root canals
- Crowns
The main benefit of private dental insurance is that it helps offset out-of-pocket costs, so you don’t carry the weight of the full bill every time you visit the dental office. The best part is that private dental insurance allows you to select a plan that meets your specific needs, whether that’s regular check-ups or more advanced treatments, so that you won’t pay for unnecessary coverage.
78% of Canadians have some type of health and dental coverage to help cover all or part of their expenses, finds a PolicyMe-Angus Reid study. With that said, individuals are 20% less likely to visit a dentist if they don’t have insurance. This means dental insurance is helping more Canadians keep their smiles healthy and minimize the portion they pay for dental expenses.
Types of private dental insurance
Most private insurance companies offer individual or family dental plans, with options for basic coverage or comprehensive/enhanced coverage. Here’s an overview of each type:
- Individual plans: Provides coverage for a single person. This is often a good choice for retirees, freelancers, or people without workplace benefits.
- Family plans: Extend dental benefits to spouses and dependents, making them more expensive than individual plans. But buying a family plan may be more cost-effective than buying multiple individual plans.
- Basic plans: Entry-level coverage for individuals or families, typically covering preventive and some basic restorative services. Premiums are often lower since coverage is limited.
- Comprehensive or enhanced plans: Include preventive, basic and major services, resulting in slightly higher premiums than the cost of basic plans.
You may have noticed we mentioned preventive, basic/restorative, and major care under the common types of dental plans. Here’s a rundown of the types of services included under each branch:
- Preventive: Covers diagnostic and routine care such as check-ups, cleanings, exams, fluoride treatments, X-rays, and sealants.
- Basic: Includes restorative treatments like fillings, minor extractions, root canals, and periodontal (gum) services.
- Major: Typically offers coverage for major restorative treatments like crowns, bridges, dentures, implants, and orthodontics (e.g., braces and retainers).
Basic plans include a mix of preventive and basic/restorative services, while comprehensive or enhanced plans usually include all three.
With that said, the amount of coverage for each type of care varies depending on the type of plan. Regardless of the plan type, preventive care typically offers the highest coverage amount, while basic and major coverage act as added layers of protection.
For example, routine exams may be covered at 80% to 100% covered with a comprehensive plan, while major procedures may be covered at 50%, with annual or lifetime maximums. Some major services may also have waiting periods, which are 6 to 12-month periods before major or orthodontic services are covered.
Private dental insurance vs. government dental care programs
Private dental insurance is a go-to choice for most Canadians because provincial health plans don’t cover routine dental care for most adults. Services like check-ups, cleanings, fillings, and orthodontics are generally excluded from public healthcare plans.
Children, seniors, and low-income families may qualify for partial coverage in some provinces, or through government programs such as the Canada Dental Care Plan (CDCP). But the eligibility rules and coverage limits leave many costs uncovered, especially for individuals who don’t qualify. For example:
- Healthy Smiles Ontario: Offers preventive and emergency dental coverage for children from low-income households, aged 17 and under.
- Alberta’s Child Health Benefit: Covers free dental coverage for children in low-income families.
- British Columbia’s Healthy Kids Program: Includes up to $2,000 of coverage for basic dental services every two years for children under 19 in families with net income below $42,000.
- Saskatchewan’s Family Health Benefits: Provides income-based dental programs for children under 18.
Keep in mind that the CDCP is only available to Canadians with an adjusted family net income of under $90,000. Individuals with an adjusted family net income between $70,000 and $89,999 only qualify for partial coverage, ranging between 40% to 60%.
Overall, private dental insurance can provide a financial cushion by covering preventive, basic, and major dental services that aren’t generally covered by provincial plans or government programs.
Bottom line: Regular provincial plans don’t provide much meaningful coverage for dental services, which leaves most Canadians paying the full cost of dental services on their own. And while the CDCP may offset some expenses for basic services (if you’re eligible), it still leaves a significant portion of the bill for more extensive care, or for those who only qualify for limited coverage.
A private plan ensures you won’t be stuck covering high dental costs on your own, and you’ll have access to a broader scope of benefits.
Is private dental insurance worth it?
Private dental insurance is typically worth it, especially if you solely rely on standard provincial healthcare, or if you only get partial coverage through a government-funded program or an employee group benefits plan. Government programs and employee benefits rarely cover everything, and standard provincial plans don’t offer any coverage for dental care.
That’s where private coverage steps in, giving you more complete protection for dental care expenses. Here are the signs it might be worth it for you:
- You don’t qualify for full coverage from government programs like the CDCP: Individuals who make over $70,000 only qualify for partial coverage, and those who make over $90,000 don’t qualify at all. Since standard provincial healthcare plans don’t offer any support for dental care, you will have uncovered expenses if you don’t gain full coverage from a government program.
- Your employee group benefits have gaps: Workplace plans often have annual maximums, service limits, or coverage gaps for major procedures or orthodontics. You’ll be left covering the rest of the cost if you don’t have additional coverage.
- You’re losing employee coverage: Retirees, freelancers, or anyone leaving a job can use private dental insurance to maintain access to affordable, consistent care.
- You want predictable costs: Private dental insurance offers steady premiums you can budget for, while also reducing out-of-pocket costs for dental services.
Who shouldn’t get private dental insurance in Canada?
Private dental insurance is typically a wise choice, but there are a few situations where it may not be the best fit.
- You already have robust group benefits: You may not need an additional private plan if your employer’s plan offers comprehensive dental coverage with high annual maximums.
- Your dental expenses are typically low: Some people have very low annual dental costs, such as one cleaning per year and no other needs (e.g., you’re consistently cavity-free). If this sounds like you, then private dental insurance may not be necessary.
Private dental insurance is a great way to protect yourself from high bills at the dental office. However, if you fall into one of the two categories above, it may be worth comparing the cost of premiums to your expected dental expenses before making a decision.
How much does dental insurance cost?
Dental insurance rates vary from person to person. Premiums are calculated based on a few key factors:
- Your age: The likelihood of needing dental work increases as we age, so rates generally climb with age.
- Your province: Average dental fees vary across provinces, which means premiums do too.
- Coverage level: Plans that only include preventive care are generally cheaper, while basic plans or major coverage costs more.
- Individual vs. family plans: Covering a single person is often more affordable than covering a whole household, but family plans typically offer better overall value.
Of these factors, age generally plays one of the biggest roles in the cost of dental insurance. Here’s an overview of how PolicyMe’s Economic health insurance rates vary by age for individuals in Alberta.
Private dental insurance costs also vary depending on the insurance provider, so be sure to compare health and dental insurance quotes from different companies before selecting a plan. Most providers, like PolicyMe, offer online quotes that only take a few minutes to fill out, so that you can find out your rate in just a few clicks.
How to get the most value out of your private dental insurance
The best dental insurance can lower the cost of standard services like cleanings or fillings, but it works best when you take full advantage of everything the plan has to offer. Here are a few ways to maximize your coverage:
- Stay on top of preventive care: Most plans offer the most coverage for services like cleanings, check-ups, and X-rays. These services are designed to maintain your oral health, and they can help you avoid costly procedures later on.
- Plan major treatments around your coverage: Your plan will likely have annual maximums for certain services, so consider scheduling major treatments (like crowns, bridges, or orthodontics) across multiple benefit years to make the most of your reimbursement limits.
- Bundle dental with other health coverage: Private dental insurance is typically paired with health coverage. You may get better value from a plan that also includes health benefits for prescription drugs, vision care, mental health services, and paramedical care.
- Know your plan’s limits: Review your reimbursement limits, co-pays, and waiting periods so you don’t get caught off guard by exclusions or face unexpected out-of-pocket costs.
- Coordinate your benefits: Consider combining private dental insurance with partial coverage from your workplace or a government-funded program to reduce your share of the cost.