Orthodontic Insurance Coverage in Canada and What Is Covered

A braces or aligner bill runs over months or years of treatment, and orthodontic insurance coverage decides how much of it a family pays to straighten a child's or an adult's teeth. That coverage comes with private dental insurance, since provincial health plans and the Canadian Dental Care Plan pay for little or no orthodontics, and this guide helps you estimate what your insurance will leave to pay before you sign a treatment plan. The first thing to check is the orthodontic section of that plan, which lists the treatments and the ages it pays for. Each source of coverage pays a different share of orthodontics:

• Provincial health plans: no coverage for routine orthodontics, with narrow exceptions for severe medical needs
• Canadian Dental Care Plan: orthodontics is not on its list of covered services for now
• Private dental insurance: a percentage of the fees, up to a lifetime maximum per person
• The balance: the medical expense tax credit, a health spending account or a payment plan can help lower what is left to pay

What Does Orthodontic Insurance Coverage Include in Canada?

Orthodontic insurance coverage in Canada usually includes comprehensive treatment with fixed braces or removable aligners, and some plans also include early, interceptive orthodontics for children. The orthodontic section of a plan brochure shows which of these a policy pays for.

Which Orthodontic Treatments Do Public Plans (Provincial Health and the CDCP) Cover?

Public plans pay for almost no orthodontics: Quebec's public health insurance plan and the Canadian Dental Care Plan exclude it, and the few provincial health services that pay for orthodontics serve narrow groups with severe medical needs.

Provincial Health Plans and Orthodontics

Orthodontics is considered dental care rather than an insured medical service, so provincial health plans such as Quebec's keep it out of their basic coverage, whatever the reason for the treatment. Appliances such as these stay at the patient's expense or go to private dental insurance:

• Braces, which move the teeth with wires fixed to each tooth
• Palatal expansion, which widens the palate
• Space maintainers, which hold the place of a tooth lost too early

Each province sets its own rules, and where exceptions exist, they are tied to a major medical need. In some provinces, a dedicated public program pays for orthodontics for children receiving income or disability assistance, or for people with severe jaw deformities.

Orthodontics and the Canadian Dental Care Plan (CDCP)

Orthodontics is not covered by the Canadian Dental Care Plan (CDCP) for now: its list of covered services leaves orthodontic services out. The CDCP is the federal government's dental plan for eligible residents who have no access to private dental insurance. It pays for other oral health care at its own fees, and a co-payment may apply based on adjusted family net income.

How Much Does Private Dental Insurance Cover for Orthodontics?

Private dental insurance covers a portion of orthodontic fees, up to a lifetime maximum. The size of that coverage depends on who the orthodontic benefit protects and on the type of plan, since group and individual plans set different terms.

How Is Orthodontic Reimbursement Calculated?

Orthodontic reimbursement is calculated in 2 steps: the plan first applies a percentage to the covered fees, then stops paying once a lifetime maximum per person is reached. Take a plan that reimburses 60% of orthodontics up to $1,500 over the patient's life: a full treatment reaches that maximum well before it ends. On a $6,000 treatment, that percentage would come to $3,600. The maximum wins: the amount paid stops at that cap, and the patient pays the remaining $4,500. Insurance rarely pays that amount at one time. Many plans spread orthodontic payments over the months of treatment, with a first payment when the appliance is placed and further payments while it is worn, so the reimbursement follows the patient's own payments to the clinic. If the coverage ends during treatment, the payments still to come may no longer be reimbursed.

Who Is Eligible Under an Orthodontic Benefit?

The people eligible under an orthodontic benefit are the ones the policy names, usually the insured person, a spouse and dependent children. When a plan covers a dependant, the coverage often stops at an age limit set by the plan, and adult orthodontics is covered only in some policies. Individual plans bought directly by a family may also limit orthodontics to dependent children, start the benefit only after a long waiting period and set a lower lifetime maximum per child.

What Separates Group Coverage From Individual Coverage?

Group coverage comes through an employer or an association, while individual coverage is a plan a person buys directly from an insurer. Both can include orthodontics, but their rules differ:

Point to compare	Group coverage	Individual coverage
Who sets the benefit	The employer or the association, in the group contract	The person buying the plan, among the insurer's options
Orthodontics	Included when the group contract provides it	Often an optional add-on, sometimes absent
Waiting period	Set by the group contract, sometimes none	Often a waiting period before orthodontics is paid

Before buying an individual plan for a child's braces, the plan brochure shows whether the orthodontic benefit exists and when a claim becomes payable.

Is Orthodontics a Separate Dental Benefit?

Orthodontics is often a separate dental benefit, apart from basic dental care, with a percentage, a maximum and a waiting period of its own. Basic care such as fillings usually has a yearly maximum that renews each year, while orthodontics has a lifetime maximum that never renews. A plan sold as full dental coverage can still leave orthodontics out, so each policy needs a check of its orthodontic benefit.

Which Insurance Checks Come Before Orthodontic Treatment?

The insurance checks that come before orthodontic treatment all happen with your insurance, before the appliance is placed. They show what the coverage pays and what the claim will leave to the patient.

1. Request a Pretreatment Estimate

Requesting a pretreatment estimate means having your insurance price the reimbursement before orthodontics starts, in 3 steps:

1. The dentist prepares a treatment plan with the planned fees and the X-rays needed.
2. The clinic sends the treatment plan to your insurance for preauthorization.
3. Your insurance replies with the amount it will pay for that treatment.

2. Check the Maximum, Co-payment, and Conditions

Checking these conditions in the plan brochure, before signing the treatment plan, shows what will be left for the patient to pay:

• The lifetime maximum, which caps the total paid for orthodontic care
• The reimbursement percentage, applied to the covered fees
• The co-payment, the share of the fees the patient pays
• Exclusions and waiting periods, which can delay coverage for a new member

Questions about any of these terms go to the plan's customer service before the first appointment, so patients know their final share.

3. Coordinate Benefits Across 2 Plans

Coordinating benefits across 2 plans, such as a person's plan and a spouse's, raises the reimbursement. The claim goes first to one plan, then the balance it leaves goes to the second, and the 2 plans never pay more than the fees charged. For a child covered by both parents, the claim usually goes first to the plan of the parent whose birthday comes earlier in the year.

What Options Lower Orthodontic Costs When Insurance Doesn't Cover Everything?

The options that lower the orthodontic costs insurance doesn't cover are the medical expense tax credit, dental financing and a health spending account, each acting on the balance left after the plan pays. That balance starts from the cost of braces in Canada: about $3,000 to $7,000 for metal braces, and $4,000 to $8,500 for ceramic braces or clear aligners. The plan's share comes off that price.

The Medical Expense Tax Credit

Orthodontic fees count among the eligible medical expenses of federal tax rules, so the part of the costs that insurance did not reimburse goes toward the medical expense tax credit. The threshold to pass depends on the level of government:

• Quebec: residents also claim a provincial credit for medical expenses on their Quebec return, with a threshold based on family net income
• Federal: expenses above the lesser of 3% of net income or $2,834 for the 2025 tax year, claimed on lines 33099 and 33199

Dental Financing Options

A payment plan spreads the cost of treatment over several months. Some clinics offer a deposit, then regular payments, monthly or every 2 weeks, until the full amount is paid. Instalments make the uninsured share payable at the pace of the treatment.

Health Spending Accounts

Some employers add an account to their benefits that reimburses eligible health and dental care expenses, including the share insurance leaves to the patient. This health spending account works as a private health services plan, and under federal tax rules the medical expenses it pays are not a taxable benefit for the employee. The account repays the expense itself, while the tax credit only reduces the tax owed for the year, and an expense the account repays no longer counts for the credit.

Pay for Your Orthodontic Treatment With Confidence at Oralvie

Once you know what your insurance covers for orthodontics, the question is how to pay the rest. At Oralvie, we accept private dental insurance for orthodontic care, including Invisalign, and we offer 2 ways to pay the remaining share: the Dentoplan platform or internal financing in payments every 2 weeks. Book your orthodontic consultation.

Frequently Asked Questions About Orthodontic Insurance Coverage

How Is Invisalign Covered Compared to Braces?

Invisalign is covered like braces under plans whose orthodontic benefit pays for removable appliances, with the same percentage and lifetime maximum as fixed braces. Aligners often cost more than metal braces, so the same maximum leaves a larger share to the patient. A plan that limits the benefit to fixed appliances leaves the whole aligner bill to the patient.

What Age Limit Applies to Children's Orthodontic Coverage?

The age limit depends on the plan: each insurer sets the age until which a dependent child stays covered for orthodontic care. That age appears in the definition of dependants or in the orthodontic benefit of the plan brochure. A treatment that starts shortly before that age is worth checking with the insurer, since the later fees may fall outside the coverage.

Is $5,000 a Lot to Pay for Braces?

That amount is a middle price for braces in Canada, inside the usual ranges of both metal braces and clear aligners. The final price depends on the appliance and on how long the treatment lasts, and the treatment plan states it before the work begins.

Is a $100 Monthly Payment Possible for Braces?

A payment of that size is possible when the balance and the term match: $2,400 left after insurance, spread over 24 monthly payments, comes to that amount each month. The clinic that offers the payment plan sets the deposit and the number of payments, so the monthly amount depends on its terms.