Dental debt and dental insurance

One in six Canadians are in medical debt, largely driven by dental bills

According to the recent PureProfile cross-country survey carried out on behalf of Compare the Market, almost 1 in 6 Canadians are in debt because of health-care costs. Canadians face an average of $8,214 in medical debt, largely driven by dental bills and prescription medication. The poll, which sampled 3,000 people across Canada, the U.S. and Australia, found Canadians faced the second highest amount of debt after the U.S.

How much an average Canadian spends for dentists every year?

According to a report published by the Canadian Institute for Health Information (CIHI) in 2019, the average out-of-pocket dental expenditure per person in Canada was approximately $392 per year. This figure includes expenses paid directly by individuals for dental services, excluding any amounts covered by insurance or public programs.

The average amount Canadians spend on dental care can vary depending on various factors such as the individual’s oral health, the specific dental procedures required, and whether or not they have dental insurance coverage. Some individuals may have higher dental costs due to more complex dental procedures, ongoing treatments, or specific oral health conditions.

How often you should visit a dentist?

The Canadian Dental Association (CDA) suggests that most adults should have a dental examination and cleaning at least once every six to twelve months. This frequency allows the dentist to assess oral health, detect any potential issues early, and provide preventive care such as professional teeth cleaning, fluoride treatments, and X-rays if necessary.

For children, the CDA recommends regular dental visits starting from a young age. Children should have their first dental visit within six months of the eruption of their first tooth or by their first birthday, whichever comes first.

OHIP and dental care

In Ontario, dental services for the general population are not typically covered by the provincial governmental health insurance plan – OHIP. However, there are some exceptions and specific programs that provide limited dental coverage for certain groups in Ontario:

1. Ontario Works (OW): Individuals receiving social assistance through the Ontario Works program may be eligible for some dental coverage. The coverage provided is usually limited to emergency dental services.
2. Ontario Disability Support Program (ODSP): Individuals who are eligible for the Ontario Disability Support Program may have access to limited dental services covered by the program. The coverage is typically focused on essential dental care.
3. Children’s Dental Care: The Healthy Smiles Ontario program provides dental coverage for eligible children and youth up to the age of 17 from low-income families. This program aims to support preventive and basic dental care for children who would otherwise face financial barriers to accessing dental services.

These programs have specific eligibility criteria and coverage limitations.

Canada moves to implement a universal dental care plan for children and low-income families. It is set to be fully implemented by 2025.

In Ontario, you have 4 options to pay for your dental needs

Generally, for the majority of adult population in Ontario, dental services are primarily can be paid in 4 ways:

1. Directly out of pocket
2. Through third-party insurance or coverage that you get from your employer
3. Through private dental insurance or coverage that you have taken out on your own
4. Through government-subsidized programs, if you meet eligibility requirements

Because not all Canadians have access to government-subsidized dental coverage, it may be beneficial for certain individuals to take out dental insurance – but it all depends on one’s personal circumstances and oral health needs.

Can I get health insurance for only dental needs?

Private dental care is often included with private health insurance plans, but you can also find dental-only plans. Dental insurance covers all basic dental treatments. Most comprehensive dental insurance plans also cover orthodontic procedures, which include braces and other corrective dental treatments. But just like many restorative services, co-payments for orthodontic procedures follow a 50:50 model (meaning you will need to pay for half of the bill).

Getting braces can be expensive. This is often the main reason why many Canadians are hesitant to get them even if the need arises. The cost primarily depends on the kind of braces you choose, with the average price ranging between $3,000 and $10,000.

Is in reasonable to have private dental insurance in Ontario?

Having private dental insurance in Ontario can be reasonable and beneficial for many individuals, depending on their specific needs and circumstances. Here are some factors to consider when evaluating the value of private dental insurance:

1. Coverage for dental expenses: Private dental insurance can help offset the costs of various dental treatments and services, including preventive care (such as cleanings and check-ups), fillings, extractions, root canals, crowns, and orthodontics, depending on the specific plan. If you anticipate needing dental treatments beyond routine preventive care, private dental insurance can provide financial assistance by covering a portion of these expenses.
2. Cost savings: Dental procedures can be costly, especially for more extensive treatments or specialized services. Private dental insurance can help reduce out-of-pocket expenses by covering a portion of the costs. This can make dental care more affordable and accessible, particularly for individuals or families with regular dental needs.
3. Access to a network of dentists: Many private dental insurance plans have a network of participating dentists. By utilizing these networks, insured individuals may benefit from negotiated rates or discounts on services provided by network dentists. This can result in cost savings compared to paying the full fee for dental services.
4. Peace of mind: Dental insurance provides individuals with peace of mind, knowing that they have coverage in case of unexpected dental issues or emergencies. It can provide financial protection and help individuals budget for dental expenses by spreading out costs through monthly premiums.
5. Flexibility and customization: Private dental insurance plans often offer various coverage options and allow individuals to tailor their plans to their specific needs. This flexibility enables individuals to choose the coverage levels, deductibles, and benefit limits that align with their anticipated dental needs and budget.

However, it’s important to carefully review the terms and conditions of private dental insurance plans, including coverage limitations, waiting periods, exclusions, and co-pays or deductibles. Factors to consider include the premiums, coverage limits, percentage of coverage for different procedures, and any waiting periods for certain treatments.

The value of private dental insurance depends on individual circumstances, oral health needs, and financial considerations. It can be helpful to evaluate your dental health history, anticipated dental needs, and the costs of various treatments when determining whether private dental insurance is reasonable for you. Consulting with dental insurance providers, comparing plans, and considering your specific dental care needs will help inform your decision.