Does private insurance cover dental services?

Dental services in Canada, including Calgary, are not covered by the public health care system, making private dental insurance an important financial tool for many Canadians. Private insurance is becoming a key factor in ensuring access to quality dental care without significant financial expense. In this article, we will take a detailed look at how private dental insurance works in Calgary, what it covers, and what options are available to city residents.

Status of public coverage for dental services in Alberta

AHCIP restrictions

The Alberta Health Care Insurance Plan (AHCIP), the province's public health insurance system, does not include most dental services in its coverage. This means that routine dental procedures such as teeth cleaning, fillings, and orthodontic treatment are not covered by the public plan. Only a few specific dental procedures, such as maxillofacial surgery, may be covered in exceptional cases.

Exceptions for special groups

Certain groups in Alberta have access to public dental coverage:

Alberta Child Health Benefit (ACHB) provides dental coverage for children in low-income families:

  • Children under 18 (or under 20 if they are in school and live with their parents)
  • Families with an income of $26,023 for a family with one child
  • Covers basic dental services: exams, cleanings, X-rays, fillings, and tooth extractions

Dental and Optical Assistance for Seniors provides coverage for seniors:

  • People aged 65+ with incomes up to $33,410 (for singles) or $66,820 (for couples)
  • Maximum $5,000 coverage every 5 years
  • Covers basic dental services: checkups, cleanings, fillings, tooth extractions, dentures

Private dental insurance: an overview

Why you need private insurance

Since dental care can be expensive, private insurance is becoming a necessity for many Canadians. According to research, approximately 64% of Canadians have access to dental insurance, primarily through employers or private plans. The remaining 35% of Canadians do not have dental insurance, which often leads to postponing or skipping dental treatment.

Types of dental coverage

Private dental insurance in Canada is typically divided into three main categories:

  1. Preventive Care - 80-100% coverage:
  • Regular checkups and consultations
  • Teeth cleaning (scaling and polishing)
  • X-rays
  • Fluoride
  • Sealants
  1. Basic Restorative Care - 50-80% coverage:
  • Fillings (amalgam and composite)
  • Tooth extraction
  • Root canal treatment
  • Gum disease treatment
  1. Major Restorative Care - 50% coverage:
  • Crowns and bridges
  • Dentures
  • Veneers
  • Implants (on some plans)

Major dental insurance providers in Calgary

Alberta Blue Cross

Alberta Blue Cross is the largest provider of dental insurance in the province, paying over $430 million annually for dental services. The company offers a variety of plans for both groups and individuals:

Group plans through employers:

  • Basic coverage with different levels (100%, 80%, 70%)
  • Includes diagnostic, preventive, restorative, and surgical procedures
  • Option to add extended services (crowns, bridges) and orthodontics

Individual plans:

  • Available to Alberta residents without group coverage
  • Reduced rates for low-income individuals
  • Different waiting periods depending on the type of service

Sun Life

Sun Life Canada offers personal health insurance with dental coverage:

Personal Health Insurance (PHI) plans:

  • Basic plan: 60% reimbursement for preventive care, $500 annual maximum
  • Extended plan: orthodontic coverage for children and adults

Health Coverage Choice:

  • For those who lose group coverage through their employer
  • No medical exam when applying within 60 days
  • Plan A: $700 annual maximum with 80% reimbursement for preventive care

Manulife

Manulife offers several dental insurance options:

Flexcare Health & Dental Insurance:

  • 7 different plans to choose from
  • DentalPlus Basic: $575-750 coverage per year
  • DentalPlus Enhanced: $840-920 coverage per year
  • ComboPlus plans combine dental with medical services

FollowMe Health & Dental:

  • For those losing group coverage
  • Guaranteed acceptance with no medical questions

Canada Life (formerly Great West Life)

Canada Life offers comprehensive health plans with dental coverage:

Freedom to Choose Health and Dental Insurance:

  • Select Plus, Select Elite, and Guaranteed Elite plans
  • 50% coverage for basic dental services
  • 100% coverage for preventive care
  • Prescription drug coverage up to $250,000

Cost of private dental insurance

Price range

The cost of private dental insurance in Calgary varies depending on the coverage and provider:

  • Basic plans: $20-50 per month
  • Standard plans: $50-80 per month
  • Comprehensive plans: $80-100+ per month

Factors affecting cost

Demographic factors:

  • Applicant's age
  • Health
  • Family size

Plan features:

  • Scope of coverage (preventive, basic, comprehensive services)
  • Annual maximums
  • Waiting periods
  • Deductibles and copayments

Waiting periods and restrictions

Standard waiting periods

Most private dental plans have waiting periods to prevent abuse:

Preventive care: usually no waiting period or 1-3 months Basic procedures: 3-6 months Comprehensive procedures: 6-12 months Orthodontics: 12-24 months

Exceptions to waiting periods

Group plans through employers: often have no waiting periods Switching plans: some companies waive waiting periods when switching from another plan

Features of the dental market in Calgary

Variation in prices for dental services

There is no standardized pricing for dental services in Alberta, which means that dentists can set different prices. Approximately half of the dentists in the province follow the Alberta Dental Association (ADA) fee guide, while the rest set their own rates.

Examples of prices for dental services in Calgary (2025):

  • New patient exam (adult): $137.65
  • Child exam: $85.91-$117.09
  • Teeth cleaning (15 min): $74.40-$83.51
  • Panoramic X-ray: $106.61
  • Composite filling: $137.68-$432.20
  • Implant: $2,700-$4,630
  • Orthodontics (braces): $2,999-$6,999

Impact of fee guides on insurance payments

Alberta Blue Cross and other insurance companies usually base their payments on the fee guide:

Alberta Blue Cross Dental Schedule: the company's own fee schedule Usual and Customary (U&C) fees: payments are based on the ADA fee guide

If the dentist charges more than what is covered by the insurance plan, the patient pays the difference.

Annual maximums and limits

Typical annual maximums

Most dental plans have annual payment maximums:

  • Basic plans: $1,000-$1,500 per year
  • Standard plans: $1,500-$2,500 per year
  • Extended plans: $2,500-$5,000+ per year

Frequency limits

Insurance plans also limit the frequency of certain procedures:

  • Checkups: once every 6-12 months
  • Cleanings: once every 6-9 months
  • X-rays: once every 12-24 months
  • Crowns: once every 5 years

Canadian Dental Care Plan (CDCP)

New federal initiative

Starting in May 2024, the federal government launched the Canadian Dental Care Plan for uninsured Canadians with incomes below $90,000:

Eligibility criteria:

  • No private dental insurance
  • Adjusted family income below $90,000
  • Canadian citizenship or permanent residency
  • Filed a tax return for the previous year

Coverage levels:

  • Income below $70,000: 100% coverage
  • Income between $70,000 and $79,999: 60% coverage (40% co-payment)
  • Income between $80,000 and $89,999: 40% coverage (60% co-payment)

Impact on private insurance

The CDCP is intended for uninsured Canadians, so individuals with private insurance cannot use both plans at the same time. However, this may affect the private insurance market, as some employers may review their benefit packages.

Practical tips for Calgary residents

How to choose dental insurance

Assess your needs:

  • Consider the current condition of your teeth
  • Plan for future procedures (orthodontics, implants)
  • Consider your family's needs

Compare plans:

  • Annual maximums
  • Coverage levels for different procedures
  • Waiting periods
  • Network of dentists

Consider group plans:

  • Typically cheaper and have better terms
  • Shorter or no waiting periods
  • Higher annual maximums

Maximizing insurance benefits

Take advantage of preventive services:

  • Regular checkups and cleanings are usually covered 100%
  • Early detection of problems saves money in the long run

Plan your procedures:

  • Spread expensive procedures out over several years
  • Use maximums before the end of the year
  • Plan around waiting periods

Get pre-approvals:

  • For procedures costing more than $300-$800
  • Avoid unexpected coverage denials

Alternatives to private insurance

Programs for low-income individuals

Centre for Newcomers Partnership: The Centre for Newcomers in Calgary partners with Nation's Dental to provide basic dental care to marginalized communities. Services include cleanings, fluoride treatments, X-rays, and oral hygiene education.

AHS Public Health Dental Clinics: Alberta Health Services operates public dental clinics for low-income families:

  • Sheldon Chumir Centre: 403-955-6888
  • Northeast Community Health Centre: 403-944-9999

Payment planning

Many dental clinics in Calgary offer payment plans or financing for expensive procedures. Orthodontic clinics often offer customized payment plans ranging from $3,488 to $6,988 for complete treatment.

Trends and the future of dental insurance

Impact of technology

Digital dentistry is changing the landscape of services and may affect insurance coverage. New technologies such as digital scanning and 3D printing may make certain procedures cheaper and faster.

Growth of preventive care

Insurance companies are increasingly focusing on preventive care as it reduces long-term costs. Coverage for preventive services and educational programs is expected to expand.

Integration with telemedicine

Teledentistry may become part of future insurance plans, especially for consultations and treatment monitoring.

Conclusion

Private dental insurance plays a critical role in ensuring access to dental care in Calgary, as the public healthcare system does not cover most dental services. Calgary residents have access to a wide range of insurance options from leading providers such as Alberta Blue Cross, Sun Life, Manulife, and Canada Life.

Key findings:

  • 64% of Canadians have dental insurance, mostly through their employers
  • Private insurance typically covers 80-100% of preventive care and 50-80% of basic procedures
  • Costs range from $20 to $100+ per month depending on coverage
  • Waiting periods are standard practice to prevent abuse

It is important for Calgary residents to carefully assess their dental needs, compare available plans, and consider both group options through employers and individual plans. With the introduction of the Canadian Dental Care Plan, some uninsured individuals now have access to basic coverage, but private insurance remains necessary for comprehensive dental care.

The right dental insurance can significantly reduce the financial burden of dental care and ensure access to quality treatment for the entire family. With the rising cost of dental services, private insurance is becoming a necessity rather than a luxury for maintaining oral health.