Insurance and payment plans

How orthodontic coverage usually works

Orthodontic benefits sit in their own category, separate from your general dental coverage, and they behave differently from it in three ways worth knowing before you read your booklet.

• Lifetime maximum. Coverage is typically capped at a set dollar amount per person for their lifetime, not per year. Once it is used, it does not reset.
• Percentage to the cap. Plans commonly pay a percentage of the fee up to that maximum, so the cap is what usually determines the benefit.
• Age limits. Many plans cover dependent children only, and some end coverage at a specific age. Adult orthodontic coverage exists but is less common.
• Paid over time. Insurers generally pay in instalments across treatment rather than in a lump sum at the start.

Bring your plan details to the consultation and we will estimate the benefit at the same appointment and submit a predetermination where that is useful. If you and a partner both carry coverage, coordination of benefits often increases the total available — worth checking, because families frequently do not.

Paying the balance

Monthly payment plans here are arranged directly through the clinic. They are interest-free, there is no credit application and no third-party lender involved, and the schedule is set to run alongside treatment. A larger initial payment reduces the monthly amount; that is the only lever, and there is no penalty either way.

Other funding worth knowing about

• Health spending accounts. Orthodontic treatment is normally an eligible expense, and a spending account can be used alongside a conventional plan.
• Medical expense tax credit. Orthodontic fees generally qualify as an eligible medical expense on a Canadian tax return. Keep your receipts and confirm the detail with whoever prepares your return.
• Timing across two benefit years. Starting near a year boundary can occasionally make better use of annual limits. We will tell you if that applies to you.