Worked Costs and Plan Checklists
Dental insurance vs paying the dentist yourself in Canada: when a dental plan pays off
Compare an individual dental plan with paying out of pocket in Canada: fee guides, coinsurance tiers, waiting periods, annual maximums, CDCP and a three-year worked example.
An individual dental plan in Canada usually pays off only if you expect more than routine check-ups, because its yearly premium is often close to what two cleanings and exams cost, and coverage for fillings, root canals and crowns is reduced by coinsurance, waiting periods and low annual maximums. If you mainly need preventive care, paying the dentist yourself, or using the federal Canadian Dental Care Plan if you are eligible, is often cheaper. If you know you need major work and can find a plan that covers it after a short waiting period, or you have children who need regular treatment, the plan can come out ahead. Run the numbers over at least two or three years, because major dental benefits often start only after year one.
This guide is part of the plan choice checklist guide. All prices and premiums are illustrative.
How dental plans pay
Most Canadian dental plans group services into tiers and pay a percentage of the provincial dental fee guide amount for each:
| Tier | Typical services | Typical individual plan coinsurance |
|---|---|---|
| Preventive / basic | Exams, x-rays, cleanings, fillings, extractions | 60% to 100% |
| Major restorative | Crowns, bridges, dentures | 50% or less, often after a waiting period of 12 months or more |
| Orthodontics | Braces, aligners | Rare in individual plans; usually a lifetime maximum when included |
Three other features matter:
- Fee guide. Each province's dental association publishes a suggested fee guide; plans pay based on a guide year, sometimes the previous year's. If your dentist charges more than the guide, you pay the difference.
- Annual maximum. Individual plans commonly cap dental at a few hundred to a couple of thousand dollars per person a year.
- Recall frequency. Exams and cleanings may be covered every 6 or 9 months, with limits on scaling units.
Worked example: three years, one adult
Assume (illustrative) your dentist charges at the fee guide and you need:
- Each year: two exams and cleanings with x-rays, total $500
- Year 2: two fillings, $450
- Year 3: one crown, $1,400
Plan: premium $45 a month ($540 a year). Pays 80% of preventive and basic to a combined $750 a year; 50% of major after 12 months, within the same $750 maximum.
| Year | Bills | Plan pays | You pay (bills - plan) | Premium | Total cost |
|---|---|---|---|---|---|
| 1 | $500 | 80% x $500 = $400 | $100 | $540 | $640 |
| 2 | $950 | 80% x $950 = $760, capped at $750 | $200 | $540 | $740 |
| 3 | $1,900 | $400 + 50% x $1,400 = $1,100, capped at $750 | $1,150 | $540 | $1,690 |
| Total | $3,350 | $1,900 | $1,450 | $1,620 | $3,070 |
Without a plan you would pay $3,350, so the plan saves $280 over three years, about $93 a year, and only because of the crown. Without the crown, bills over three years would be $1,950; the plan would pay $400 + $750 + $400 = $1,550, leaving you $400, and with $1,620 of premiums the total would be $2,020, or $70 more than paying yourself. The annual maximum is what limits the benefit in a bad year.
The Canadian Dental Care Plan changes the comparison
If your adjusted family net income is under $90,000 and nobody in the family has access to private dental coverage, the Canadian Dental Care Plan may pay all or most of these costs at CDCP fees, with no premium. Buying an individual dental plan makes you ineligible for CDCP. So check CDCP first. Note that CDCP requires preauthorization for crowns and does not currently cover orthodontics.
When a dental plan is more likely to pay off
- You have children with frequent treatment needs and the plan covers basic work from day one.
- You know you need basic work (several fillings or root canals) and the plan covers basic services without a long wait.
- The plan's annual maximum is high relative to its premium.
- You value spreading the cost evenly over the year.
When paying yourself is usually better
- You only need preventive care and your mouth is stable.
- The plan's maximum is low and the major work you expect would exceed it anyway.
- You qualify for CDCP.
- Your dentist offers a payment plan or you can save in advance in a dedicated account.
A simple decision test
- Price your expected work over three years (ask your dentist for a treatment plan with fee codes).
- For each year, compute plan payment = min(coinsurance x eligible amount, annual maximum), allowing for waiting periods.
- Add three years of premiums.
- Compare total cost with the bills. Use the plan comparison tool one year at a time, entering the coinsurance share in the second field.
- Remember that what you pay, including premiums, counts toward the medical expense tax credit either way.
Mistakes to avoid
- Buying a plan right before major work without reading the waiting period.
- Ignoring the fee guide difference if your dentist charges above it.
- Assuming orthodontics is included. It rarely is in individual plans.
- Cancelling after one year of no claims, then needing major work and facing a new waiting period.
Frequently asked questions
Can I get a predetermination before treatment?
Yes. Ask your dentist to send a predetermination (pre-estimate) to the insurer for major work. It shows what the plan will pay before you commit.
Do dental plans cover implants?
Some richer plans cover implants as major services; many individual plans exclude them or cap them tightly. Read the schedule of benefits.
Is a dental-only plan available?
Some insurers sell dental as a stand-alone plan; others require you to buy it with health coverage. Compare total cost either way.
Sources
- Canadian Dental Association — patient information and links to provincial dental associations and fee guides
- Canadian Dental Care Plan on Canada.ca — eligibility and coverage
- Canadian Life and Health Insurance Association — how dental insurance works
- Canada Revenue Agency — dental expenses and premiums for the tax credit
