How Does Dental Insurance Work in Canada?
What is dental insurance?
Dental insurance is a type of health insurance that specifically covers dental treatments. Some policies cover only very basic procedures, and others cover everything from cleanings to orthodontics and major surgery. It helps you save on dental costs by reducing out-of-pocket expenses.
Canadians have several options for dental coverage:
- Individual private dental insurance: Buy a policy and pay a monthly or annual premium, then share the cost of coverage with your provider. Great for self-employed Canadians, families without employer benefits, or people who don’t qualify for government programs.
- Employer-sponsored dental insurance: Many full-time jobs in Canada come with dental benefits, and the employer usually pays group plan premiums, in part or in full.
- Government-supported programs: Each province runs dental programs for eligible groups, like low-income families, kids, and seniors. Coverage varies by region and is often limited to essential care. There’s also the Canadian Dental Care Program (CDCP).
Most dental health policies are add-ons to private individual health insurance plans, though there are some standalone dental plans in Canada.
How dental insurance works
Here are some key terms that will help you understand how dental insurance works in Canada:
- Premium: You pay a premium monthly or annually to maintain your dental insurance coverage. This is a fixed cost that keeps your policy active.
- Deductible: The deductible is the amount you must pay out of pocket for dental services before your insurance starts covering a portion of the costs. It is typically an annual amount.
- Co-pay: A co-pay is a fixed fee you pay for specific dental services at the time of the visit. For example, you might pay a small fee for each office visit or procedure.
- Coinsurance: Coinsurance is the percentage of the cost of a dental service you are responsible for paying after you've met your deductible. For example, if your insurance covers 80%, you would pay the remaining 20%.
- Annual maximum: The annual maximum is the total amount your dental insurance will pay for your dental care within a plan year or calendar year. Once you reach this limit, you must cover additional costs out of pocket.
- Claim: A claim is a request for payment that you or your dental provider submits to your insurance company after receiving dental services. The insurance company then processes the claim and pays its share of the costs.
- Waiting period: A waiting period is when you must wait after your policy begins before certain dental services are covered. This can vary depending on the procedure and the insurance plan.
In practice, dental insurance works similarly to health insurance:
- Purchase a policy with a certain type of coverage
- Pay a monthly premium to maintain coverage
- Pay a co-payment when you need dental care
- Insurance company kicks in to cover the rest, up to the policy’s limits
Dental plans have coverage models—they cover a percentage of the cost per type of service, up to an annual maximum, and after a specific waiting period.
For example, here are two examples of how dental policies might be structured in Canada:
- Example Policy A: Covers 60% of basic services up to $750 per year after three months and 80% of major services up to $1,000 per year in year 2 and beyond
- Example Policy B: Covers 70% of basic services up to $600 per year, 80% of preventative services up to $500 per year in year 2 and beyond, and 50% of major services up to $2,500 every year after year 3
“Usually, any plan that covers north of 75% of the health expenses is considered a strong plan.” —Andrew Ostro, CEO & Co-founder, PolicyMe
What dental insurance covers (and what it doesn’t)
Private dental insurance may cover any type of dental care, from cleanings and fillings to orthodontics and dentures.
Private dental care helps close the gap in provincial and federal dental coverage for Canadians.
Canadians do have some provincial and federal options for subsidized healthcare and dental care; however, many Canadian families don’t qualify for government coverage or end up with large gaps.
- Provincial coverage: Many provincial health plans in Canada do not cover dental care for every adult and child. Some, but not all, offer basic dental coverage for low-income families or seniors. Most plans only cover dental care for residents if it’s medically necessary and takes place in a hospital.
- Federal coverage: The Canadian Dental Care Plan (CDCP) launched in 2024 to provide free comprehensive dental care for qualifying Canadians across the country. Not everyone is eligible, and not all services are covered.
- Private coverage: Get exactly the dental coverage you need, from preventative-only to major services and orthodontics.
Private dental insurance will cover a specific percentage of a service, depending on the category of service:
Preventative services (typically covered up to 100%)
- Routine check-ups: Regular exams help monitor your oral health and catch problems early.
- Cleanings: Professional cleanings remove plaque and tartar, preventing cavities and gum disease.
- X-rays: Annual diagnostic X-rays help detect issues like cavities, bone loss, and impacted teeth that aren't visible during a regular exam.
Basic services (typically covered 70–80%)
- Fillings: Fillings are the solution to painful cavities, and insurance typically covers a significant portion.
- Extractions: Remove decayed or damaged teeth to maintain oral health and eat comfortably.
- Periodontal treatment: Treat gum disease with procedures like scaling and root planing.
Major services (often covered 50–80%)
- Root canals: If a tooth is infected or damaged, a root canal can save it.
- Crowns: Crowns cap and protect damaged teeth to restore function and appearance.
- Bridges and dentures: Replacing missing teeth with bridges or dentures can be crucial for function and aesthetics.
Orthodontic treatment (Coverage varies)
- Braces: Children are more likely to have orthodontic coverage, but it sometimes applies to adults, too.
- Retainers: Retainers help maintain alignment after braces.
What’s not covered? Cosmetic procedures such as whitening and veneers are almost never covered. Elective, experimental, and orthodontic treatments for adults are usually excluded. Lost or stolen dental appliances and over-the-counter medications are not normally covered, either.
Mandatory waiting periods are typical before qualifying for services. They’re normally three months for basic services, and either one, two, or three years for higher-cost items like surgeries and orthodontics.
How dental insurance claims work
Dental insurance claims typically work in one of two ways:
- Reimbursement: The patient pays the office directly and then files for reimbursement.
- Direct billing: The dental office files the claim directly with the insurance provider.
It depends on your insurance company and the dental office. Ask before you book a service to ensure you know what to expect.
Here’s what to expect when you file for reimbursement after paying out of pocket:
- Pay out of pocket for the service
- Keep your receipts
- File a digital or paper claim with the company
- Wait to hear back about approval
- Receive reimbursement via cheque or direct deposit
Here’s how it works when the dental office is direct billing:
- Provide your insurance information, including policy number
- You pay a co-pay upfront, if applicable
- Office submits the bill directly to the provider
Digital claims tend to be processed faster. Processing can take anywhere from a few days to 45 days, depending on the complexity of the service and the claim.
Some procedures require pre-authorization before insurance will cover them. Your healthcare or dental provider must submit your patient record, evidence, treatment plans, and estimated costs to the insurance company ahead of time.
How much does dental insurance cost?
The cost of private dental insurance in Canada is between $40 and $150 per month for most adult Canadians. It depends on the plan and the policyholder—for instance, younger people tend to pay less.
Here’s a look at premiums for various ages of Canadians who get dental insurance through PolicyMe:
Remember, premiums are just the monthly cost you pay for the policy. You should also budget for anything beyond your annual maximum or coverage limit.
Is dental insurance worth it?
Dental insurance is worth it if you’d spend less on a policy than you’re planning to spend out of pocket for dental care. Oral healthcare is an important part of your overall health, yet 35% of Canadians don’t have dental insurance.
Dental insurance can be a great way to manage your costs without neglecting your oral health. Get the most out of your dental insurance by:
- Getting regular check-ups: Book dentist appointments regularly. Cleanings and exams can help find and solve issues earlier, before they turn into expensive major concerns.
- Knowing your policy: Read your dental insurance policy carefully to understand what it covers and what it doesn’t.
- Planning big treatments: Talk to your dentist and insurance company if you need major dental work to make sure you stay within your coverage limits.
- Using preventive services: Take full advantage of preventive services like cleanings and fluoride treatments to help keep your teeth healthy.
How to choose the right dental insurance plan in Canada
Follow these steps to pick the right dental plan that covers what you need without forcing you to overpay for unnecessary coverage.
- What do you need? Start by identifying the types of dental care you and your family need. Some people need basic cleanings and coverage for unexpected surgeries. Others may need orthodontics for children, bridgework, or other types of care.
- What am I eligible for? Find out what provincial and federal services you can get for free. The CDCP has income and access-related criteria, as do provincial health programs.
- Who offers what I need? Request quotes from private insurance companies that offer coverage that aligns with your needs. Compare prices and make sure you’re going to save money.
- What’s the best option? Cost is a major factor, but it’s not the only one. Read customer reviews and online ratings. Find out how fast they process claims and how friendly their team is.
FAQ: How does dental insurance work?
Prices listed on this page are based on information available as of October 2025. The prices shown are for general reference only and may vary based on factors like your age, location, and product selection.