Going to the dentist isn’t always fun and can get overlooked. But, oral health is important to your overall health, and the longer you avoid going to the dentist could spell trouble for your teeth and your wallet.
One way to keep consistent with your oral health is by having adequate dental insurance, a form of health insurance, to cover some or all of the costs associated with dental services. Paying for dental services out of pocket can be expensive. In fact, in 2018, 22.4% of Canadians (roughly 6.8 million people) avoided visiting a dental professional due to cost according to Statistics Canada.
Ontario Health Insurance Plan (OHIP) covers all Ontario residents, but only certain dental situations are fully covered. This could include oral surgery provided in a hospital and only in extreme situations, such as:
Many people think that the above services are OHIP services, but they’re OHIP dental coverage, meaning dentists provide the service and bill OHIP.
But OHIP dental coverage does not cover regular dental services, such as check-ups, cleanings, x-rays and root canals/tooth removals.
Each dental insurance plan will be different in what services are offered, but there are generally four basic plans that insurance companies will have. Of course, these plans might vary slightly from insurer to insurer, so it’s best to find out what exactly each plan covers.
Dental insurance is a straightforward product that is either called individual insurance or group insurance. Each insurance package varies in price and coverage of dental services offered.
Individual insurance is covered for single people, couples, or families, while group insurance is referring to employee benefits that are purchased by companies for their employees.
There are even some services that are add-ons to extend an insurance policy for both individual and group.
Depending on your eligibility, each province has their own government dental programs. Click on your province below to learn more.
Have more questions about dental insurance? Here are some answers to dental basics.
The short answer is yes, there is free dental care in Ontario, but only if you meet certain eligibility requirements.
Healthy Smiles Ontario is one government program that offers free dental services to children and youth 17 years old and younger who come from low income households.
The program provides regular visits to a dental provider while covering costs for services such as check-ups, cleanings, fillings, x-rays and emergency services. Braces and teeth whitening aren’t covered.
There is also free dental care for seniors 65 years of age and older from low income households called the Ontario Seniors Dental Care Program. The program provides free routine visits while covering costs for services such as check-ups, repairing broken teeth, x-rays, removing teeth, treating pain and gum conditions.
Another tricky question to answer, but the short answer is yes, because each province has some form of dental care that’s free to those who are eligible. The longer answer is no, there isn’t a free dental care program across the country, but each province has their own government dental programs that offer free services, often to youth and seniors from low income households and/or on disability.
Dental care isn’t included in the Canada Health Act, and most residents who aren’t eligible for free dental care, or don’t get benefits through their employer, end up paying for services through private insurance or out of their own pocket.
This depends on what is best suited for your needs and budget. If your teeth and oral health are in good standing, a basic plan would suit you over a more comprehensive plan.
If you have kids, you might benefit from an orthodontic plan, since many kids end up getting braces at a young age.
Some plans might also have dental add-ons that you can pay extra for as your budget and needs change.
A premium is the amount of money an individual or business pays for their insurance policy. Along with the package you pick, different factors come into play when calculating the premium, including your age, dental records, and illness history.
Other factors like the location you live in and how many dependents are in your family also affect the premium.
To claim dental benefits, a form must be completed and submitted to your claim provider. If you have insurance through your employer, you can ask Human Resources for assistance or customer service at your plan provider.
When submitting a claim to dental insurance providers, you have to follow a specific process set out by the dental insurance provider you've chosen. Paperwork must be filled out detailing the type of treatment, clinic, costs and other details. After you've filled out the paperwork, it will go through the approval process with your dental care insurer. The length of time for approval ranges with each firm.
Group benefits, also known as employee benefits, are part of the compensation package for employees that help cover some or all medical and dental costs.
Each group benefit package is different in what is covered. Some benefit packages cover up to a certain allotted monetary amount, while others cover up to a certain percentage. For example, one employer might cover up to 80% of basic dental procedures, while another employer might reimburse up to $500 for any dental work.
If some employee benefit packages don’t cover everything you need, your employer might have options for specific add-ons to your coverage or let you personalize your benefits. In some cases, add-ons and personalization aren’t available, you can consider getting private insurance to help bridge the gap of your employee benefits.
Part-time or contract employees generally won’t be eligible for benefits, so you would need to get private insurance or pay for any work out of your own pocket.
If you’re a freelancer or self-employed, you might be thinking that group benefits aren’t even an option for you.
If this is the case, your decision on getting insurance will have to be partly based on knowing your oral health, which can be tricky.
Some people have a history of bad oral health and will need a lot of dental work done in a year, so having insurance could help reduce overall costs.
Another thing to consider is if you’re only paying for yourself and only need routine checkups, you could save more by paying out of pocket than with insurance. On the other side of that, if you have a spouse and/or kids, getting insurance could save you money rather than paying out of pocket for the whole family.
Before deciding on getting insurance or not, make sure you know what’s covered, because not every plan has what you need. Some plans also come with yearly spending limitations or limiting procedures, such as only covering certain emergencies.