Covering Kids with Dental Insurance: Is It Worth It?

Dental Insurance for Kids in Canada (Quick Guide!)

PolicyMe Editorial Team

September 18, 2024

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Key Takeaways

Comprehensive Coverage: Kids' dental insurance typically covers preventive care (cleanings, exams, fluoride) and restorative treatments (fillings, crowns). May also include orthodontics, depending on the type of dental insurance.
Choosing the Right Plan: Consider factors like coverage options, premium cost, deductibles and orthodontic care.
Cost Considerations: Costs vary by plan; more comprehensive coverage usually means higher premiums but can save money in the long run.
Orthodontics & Limitations: Not all plans cover braces and there may be limitations on preventive visits or exclusions for cosmetic treatments.

What is Dental Insurance for Kids in Canada?

Dental insurance for kids helps parents manage the cost of their children’s dental care. It can cover essential dental treatments and preventive services, including routine check-ups, cleanings, fluoride treatments, sealants, fillings, and emergency care. The goal is to maintain your child’s oral health and address any issues early, before they become more serious.

There are two main types of dental coverage available in Canada: public dental programs and private insurance plans.

Public Dental Programs for Kids in Canada

Across Canada, several provinces offer public dental care programs designed to support low-income families or those without private insurance. These programs ensure that children receive necessary dental care regardless of their family’s financial situation. Here’s a closer look at the dental care programs available in different provinces:

Healthy Smiles Ontario

Healthy Smiles Ontario is a comprehensive, government-funded program that provides free dental care to children and youth under 18 from low-income families. The program covers a range of services, including routine check-ups, cleanings, fillings, and other essential treatments. To qualify, families must meet specific income requirements, which are updated annually. This program aims to ensure that every child has access to the dental care they need for healthy development.

British Columbia’s Healthy Kids Program

In British Columbia, the Healthy Kids Program offers dental services to children and youth under 19 whose families receive Medical Services Plan (MSP) Premium Assistance. This program includes basic dental care services such as exams, cleanings, fillings, and extractions. Eligibility is based on the family’s income level, and those receiving premium assistance are automatically enrolled. The Healthy Kids Program is designed to reduce financial barriers to essential dental care and support the overall health of children.

Alberta Child Health Benefit

The Alberta Child Health Benefit provides dental care coverage for children under 18 from lower-income families. This program covers a wide range of dental services, including preventive care, fillings, and emergency treatments. To be eligible, families must meet income criteria and be residents of Alberta. The program is intended to alleviate the cost of dental care and ensure that children receive necessary treatments to maintain their oral health.

Private Dental Insurance for Kids in Canada

Private dental insurance can be purchased as a standalone plan or added as part of a family health insurance package. These plans offer more comprehensive coverage and greater flexibility in choosing dental providers. Services typically covered by private insurance include:

Preventive care: Regular check-ups, cleanings, fluoride treatments, and sealants.
Basic dental care: Fillings, extractions, and minor repairs.
Major dental care: Orthodontic work, crowns, and root canals (depending on the plan).

Most private dental insurance plans have annual maximums, meaning they will cover costs up to a certain limit each year. Some plans may also require co-pays or deductibles, so it’s important to review the details carefully!

Should You Get Dental Insurance for Your Kids?

Good dental health is essential to a child’s overall well-being. Regular dental visits help prevent cavities, gum disease, and other oral health issues. Without kids' dental insurance coverage, these treatments can quickly become expensive. A good dental plan ensures that children get the care they need without burdening parents with high out-of-pocket expenses. Investing in kids' dental insurance early can help prevent long-term dental problems.

What Does Dental Insurance for Kids Cover?

Most kids' dental insurance plans cover a range of services, but they usually cover:

Preventive care: Cleanings, exams, and fluoride treatments to maintain good oral hygiene.
Restorative treatments: Fillings, crowns, and root canals to fix dental issues.
Emergency care: Treatment for unexpected problems, such as tooth injuries or severe infections.
Orthodontic care: In some cases, insurance may also cover braces.

It is important to choose a plan that covers your child’s specific needs, including preventive care, which helps maintain their dental health over time. And be sure to read your policy closely to make sure you understand what is and isn't included!

3 Things to Look Out for When Choosing Dental Insurance for Your Child

Choosing the right plan can feel overwhelming, but considering the following factors can help simplify the decision:

Coverage options: Does the plan include comprehensive services, such as orthodontics?
Premiums & deductibles: What’s the monthly premium, and how much do you need to pay before coverage kicks in?
Additional benefits: Look for extra coverage, such as braces, if your child may need orthodontic care in the future.

How Much Does Dental Insurance for Kids Cost?

The cost of kids' dental insurance in Canada varies depending on the plan. Generally, more comprehensive coverage comes with a higher premium. However, the investment can save you significantly on future dental expenses.

What Should Parents Know About Dental Insurance and Orthodontics?

Orthodontic care, such as braces, can be expensive, and not all kids' dental insurance plans cover it. If you’re looking for coverage for braces, make sure to verify whether orthodontics is included in your plan or if you need additional coverage. Many families opt for plans that provide partial coverage, reducing the out-of-pocket costs for braces.

Emergency Dental Care Coverage

If your child needs emergency dental care, the first step is to contact your dentist or an emergency dental clinic as soon as possible. Most dental insurance plans provide coverage for emergency situations, but the extent of coverage can vary depending on your specific policy. Here's what you can generally expect:

Immediate Care: Your child will receive immediate attention to address pain, stop bleeding, or prevent further damage.
Coverage: Many dental insurance plans cover emergency treatments, such as tooth extractions, pain relief, or repairs to broken teeth. However, there might be limitations or exclusions, so it's essential to review your policy details.
Co-pays and Deductibles: You may have to pay a co-pay or meet a deductible before the insurance covers the emergency care. Check with your insurance provider to understand these costs.
Pre-Authorization: Some insurance plans require pre-authorization for certain types of emergency treatments. It's a good idea to contact your insurance provider to verify coverage before proceeding with extensive treatments, if possible.
Follow-Up Care: After the initial emergency treatment, follow-up visits might be necessary. These visits may also be covered, but check your policy to understand what is included.

In summary, while most dental insurance plans cover emergency dental care for children, it’s crucial to review your policy and understand any potential costs and requirements.

How Can You Obtain Dental Insurance for Kids?

In Canada, parents can obtain kids' dental insurance through private insurers or government programs. The process is simple: compare different plans, check for eligibility, and apply either online or through an insurance broker. Low-income families might qualify for government assistance programs, ensuring their children receive the dental care they need without financial strain.

Summary: Guide to Children's Dental Insurance Coverage in Canada

Essential Coverage: Kids' dental insurance helps manage high dental care costs, covering preventive, restorative, and sometimes orthodontic treatments.
Plan Selection: Choose a plan based on coverage options, costs, and any limitations or exclusions.
Government Assistance: Programs like Healthy Smiles Ontario help low-income families with affordable dental care.
Private Insurance Benefits: Private plans may offer broader coverage, including orthodontics and more extensive services.
Financial Relief: Dental insurance reduces out-of-pocket expenses, ensuring children receive necessary care without financial strain.

Frequently Asked Questions: Dental Insurance for Children

Are regular check-ups and cleanings fully covered, or is there a co-pay?

Regular check-ups and cleanings for kids are often covered by dental insurance, but the extent of the coverage can vary depending on the plan. Most dental insurance plans for children cover preventive care, which includes routine check-ups and cleanings, at 100%. However, there can still be some out-of-pocket costs. For instance, some plans may require a small co-pay for each visit, or there might be a deductible that needs to be met before the insurance starts to cover the costs. Additionally, there could be limits on the number of covered cleanings per year, typically twice a year. It's essential to check the specifics of your child’s dental insurance policy to understand the coverage details and any potential out-of-pocket expenses.

At what age does pediatric dental coverage typically begin and end?

Pediatric dental coverage typically begins at birth and continues until a child turns 18. Some insurance plans may extend coverage slightly beyond the age of 18, especially if the child is still a dependent and enrolled in school. It's important to review the specifics of your dental insurance policy to understand the exact age limits and any conditions that may apply.

Are sealants and fluoride treatments covered under my child's dental plan?

Sealants and fluoride treatments are often covered under children's dental plans, but the coverage can vary depending on the specific plan. Many dental insurance plans recognize the importance of preventive care and include coverage for sealants, which are protective coatings applied to the chewing surfaces of back teeth to prevent cavities. Fluoride treatments, which help strengthen the teeth and prevent decay, are also commonly covered. However, there may be limitations on the frequency of these treatments and age restrictions for coverage. To understand the exact details of what is covered, it's important to review your child’s dental insurance policy or contact the insurance provider directly.

Does dental insurance for kids cover the cost of dental x-rays?

Most dental insurance plans include coverage for diagnostic services, which typically encompass dental X-rays. These X-rays are often fully or partially covered, especially when they are part of routine check-ups. However, the specifics can vary depending on the plan. There may be limits on how often X-rays are covered, such as once a year or once every few years. Additionally, basic X-rays, like bitewings, are usually covered, while more extensive X-rays, like panoramic or full-mouth series, might have different coverage terms. There could also be co-pays or deductibles associated with X-rays. To get the most accurate information, it’s best to review your specific dental insurance policy or contact your insurance provider.

Does the plan cover dental care for children with special needs?

Whether a dental insurance plan covers dental care for children with special needs can vary depending on the specific plan and provider. Generally, most dental insurance plans do cover essential dental care for children, including those with special needs. However, the extent of the coverage and any additional services required for special needs may differ.

Some plans may offer more comprehensive coverage, including specialized treatments and accommodations. It's important to review the details of the insurance policy and consult with the provider to ensure that the specific needs of the child are fully covered. Additionally, some states have specific regulations and programs that provide additional support for children with special needs, which can complement private insurance plans.