Orthodontic costs in Canada: what plans typically cover, and what they don't

Orthodontic treatment can help correct issues with teeth and jaws, such as misaligned teeth, gaps, or bite problems. Understanding how these services are covered by different plans in Canada can help you plan for potential costs.

Canadian Dental Care Plan (CDCP) and Orthodontics

The Canadian Dental Care Plan (CDCP) helps cover a portion of costs for a wide range of oral health care services [1]. It is important to note that orthodontic services are not yet available under the CDCP [1]. While the CDCP covers many general dental services like exams, cleanings, fillings, root canals, gum treatment, dentures, and oral surgery, these are distinct from orthodontic care [1]. A specific range of orthodontic services will be available in the future, at a date to be determined, and preauthorization will be required for orthodontic treatment once it becomes available [1]. This means that being enrolled in the CDCP does not currently cover the cost of braces or aligners. The Government of Canada sets out the eligibility rules and co-payment tiers for general dental services on the CDCP coverage page [1], and we walk through them in our guide to dental costs and the Canadian Dental Care Plan.

How private plans usually structure orthodontic coverage

Where orthodontic treatment is covered in Canada today, it is almost always through a private extended health or dental plan — and orthodontic benefits are usually built differently from the rest of a dental plan. The specific amounts vary by plan and are set by whoever purchased it, so ask your insurer for your own numbers rather than relying on any general figure. The structural features to ask about are these:

• A separate lifetime maximum. Orthodontic coverage typically sits in its own benefit category with a lifetime maximum per person, rather than the annual maximum that applies to general dental work. Once it is used, it does not reset the following year.
• An age limit. Many plans restrict orthodontic benefits to dependent children under a stated age. Adult orthodontic treatment is excluded under a good number of plans, so this is worth confirming before an adult starts treatment.
• Percentage reimbursement. Plans commonly reimburse a percentage of eligible orthodontic costs rather than the full amount, with the remainder owed by you.
• Treatment that spans years. Active orthodontic treatment usually runs over several years. This extended timeline means that your coverage situation can change partway through treatment. For example, you might change jobs, which could lead to a change in your insurance provider or plan terms. If your plan changes, the new plan might have different coverage rules, a different lifetime maximum, or even no orthodontic benefit at all. For children undergoing treatment, an age limit on dependent coverage is also a factor. If a child reaches the plan's age limit for orthodontic benefits while still in active treatment, the plan may stop covering costs from that point forward. It is important to ask your insurer what happens to your benefit if your coverage changes or ends mid-treatment, as the answer is not always intuitive and can significantly impact your out-of-pocket expenses.
• Coordination of benefits. If two plans cover the same person, they can sometimes be combined, though the combined payment will not exceed the eligible cost.

Understanding Orthodontic Costs and Payment

Orthodontists typically structure payment for treatment in a specific way. This often involves an initial payment, followed by a series of instalments paid over the active treatment period.

Before starting any significant orthodontic treatment, your orthodontist's office can provide a pre-treatment estimate. This document outlines the proposed treatment plan and its estimated costs. It is advisable to ask the office to submit a predetermination to your insurance provider before beginning treatment.

The Value of a Predetermination

A predetermination is a formal request sent to your insurer by the orthodontist's office. It asks the insurance company to review the proposed treatment plan and confirm what portion of the estimated costs they will cover. This step is crucial because it provides an estimate of your out-of-pocket expenses before you commit to treatment.

It is important to understand that a predetermination is an estimate, not a guarantee of payment. The final amount covered by your plan can sometimes differ based on various factors, such as changes in your policy, benefit maximums being reached, or other claims submitted before the orthodontic treatment is complete. However, receiving a predetermination allows you to have a clearer picture of your financial responsibility and can help you make an informed decision.

Questions to Ask Your Orthodontist's Office

Before committing to orthodontic treatment, it is helpful to have a detailed discussion with the orthodontist's office about all aspects of the costs and payment. Consider asking the following questions:

• What is included in the quoted treatment fee? Clarify whether the quoted figure covers the entire treatment from start to finish.
• Are there any additional costs? Ask if items like initial records (X-rays, photos, models), retainers after active treatment, emergency visits, or repairs to appliances are included or if they will be extra charges.
• What is the payment schedule? Understand the breakdown of payments, including any initial down payment and the frequency and amount of subsequent instalments.
• What happens if treatment takes longer than expected? Inquire about the financial implications if the active treatment period extends beyond the initial estimate. Will there be additional charges for extended treatment, or is it covered by the original fee?
• What if I change my insurance plan or job during treatment? Discuss how changes in your insurance coverage might affect your payment plan and what steps you would need to take.
• What are the options for payment? Ask about available payment methods, financing options, or any discounts for upfront payment.
• Will the office submit claims on my behalf? Confirm if the office handles submitting insurance claims or if this is your responsibility.

What is an Orthodontist?

An orthodontist is a dentist who has completed additional specialized training in orthodontics. This training focuses on diagnosing, preventing, and treating dental and facial irregularities. Orthodontists are registered with their provincial dental regulatory bodies.

Orthodontists are dentists with additional specialty training, and they are registered with the dental regulator in their province — that is where a registration check belongs. Examples are the Royal College of Dental Surgeons of Ontario [3], the College of Dental Surgeons of Alberta [4], and the British Columbia College of Oral Health Professionals [5]. The Canadian Association of Orthodontists is a national professional association rather than a regulator, so it cannot confirm a registration, though it is a reasonable place to read about the specialty [2]. If you are looking for an orthodontist, you might search for orthodontists in Calgary, orthodontists in Vancouver, or orthodontists in Burnaby.

What this means for you

Understanding the costs and coverage for orthodontic treatment in Canada involves checking with different sources. The Canadian Dental Care Plan does not currently cover orthodontic services, though a specific range of services will be available in the future, requiring preauthorization [1].

It is important to remember that the need for orthodontic treatment varies greatly from person to person. Whether treatment is advisable for you or your family member is a clinical question that should be assessed by a registered dentist or orthodontist.

For any dental care, including future orthodontic services under the CDCP or current services under private plans, it is important to:

• Discuss the full treatment plan and estimated costs with your oral health provider.
• Ask your provider to submit a predetermination request to your insurance provider to understand what portion of the costs may be covered.
• Inquire about any potential co-payments or additional charges you may be responsible for, especially with the CDCP's income-based co-payment structure [1].

A licensed oral health professional can assess your specific situation and help you understand your treatment options and associated costs.

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