Guide to Medical and Dental Insurance in Canada

Canadians benefit from universal healthcare—which means many of your medical and healthcare needs are covered by government plans.

But what happens when they aren’t?

Medical and dental insurance can be a great option to fill the gaps.

So, keep reading as we break down what it is, why you need it—even with universal healthcare, and the best way to find the right medical and dental insurance plan for you.

Key Takeaways

Medical and dental insurance plans typically cover many healthcare needs that aren’t covered by government healthcare plans, from prescription drugs to major dental procedures.
Both medical and dental insurance plans often include preventive care services, such as annual check-ups and dental cleanings, to help maintain overall health.
Familiarize yourself with insurance terms like premiums, deductibles, and co-pays to better manage your healthcare expenses and choose the right plan.
Finding an affordable and comprehensive medical and dental insurance plan is easy with PolicyMe.

What is Medical and Dental Insurance?

Medical and dental insurance are two essential components of health coverage that protect you and your family from unexpected healthcare costs.

In Canada, these insurance plans go above and beyond what is covered by provincial and government healthcare plans.

Medical insurance covers many common healthcare needs, including prescription medications, hospital service and ambulance services, and paramedical services. It's designed to ensure you have access to necessary medical services without overwhelming out-of-pocket expenses.

Dental insurance, on the other hand, focuses on covering the costs of dental care, such as routine check-ups, cleanings, fillings, and more extensive procedures like root canals or orthodontics. While some Canadians may be eligible for the Canadian Dental Care Plan, most Canadians get dental coverage through private plans.

The importance of dental insurance has grown as the costs for dental services increase year over year, making it more challenging for families to afford necessary care without coverage.

Additionally, the cost of drugs and other medical resources has increased consistently for about 5 years now.

With medical and dental insurance, you're better equipped to manage these rising costs, so you and your family can receive the care you need when you need it.

Terms of Medical and Dental Insurance

Let’s face it. Health insurance can feel overwhelming—and don’t worry, you’re not alone. But understanding the key terms related to medical and dental insurance can help you better navigate insurance options and make informed decisions when choosing the right coverage.

Here are some common terms you might see when searching for medical and dental insurance and what they mean.

Premium: The amount you pay, usually monthly, to maintain your insurance coverage.
Deductible: The amount you must pay out-of-pocket before your insurance begins to cover expenses.
Co-pay: A fee you pay for specific services, such as a prescription, as part of your coverage.
Co-insurance: The percentage of healthcare costs you're responsible for, with your insurance covering the rest.
Out-of-Pocket Maximum: The maximum amount you'll have to pay in a year, after which your insurance covers 100% of eligible expenses.
Adjudicated Drug Costs: The total cost of prescribed medications that have been processed and approved by your insurance provider for payment.
Preventive Care: Services like check-ups, vaccinations, and screenings that are covered by your insurance to help prevent illness.

Benefits of Medical and Dental Insurance Plans

Medical and dental insurance plans provide peace of mind, knowing that you won't be hit with hefty bills for medical or dental procedures.

Insurance means you can access necessary care without worrying about the financial burden, whether a routine check-up, an emergency visit, or a complex medical matter. But unlike home insurance, for example, medical and dental insurance plans cover the cost of a lot of ongoing and preventative care, such as dental cleanings or chiropractic services. It’s less about if you’ll need it and more about how much.

One of the key benefits of insurance is the cost savings. Without insurance, out-of-pocket medical and dental care costs can be significant. For example, dental services alone can be quite expensive, and as costs rise year over year, uninsured individuals may find themselves paying more than necessary.

This is where medical and dental insurance plans come in handy. They help to avoid situations where Canadians waste money by paying full price for services that could have been covered under a well-chosen insurance plan. While you’ll be paying for the premium, the coverage can often significantly outweigh the costs.

And unlike something like car insurance, medical and dental insurance coverage is less about if you’ll need it and more about when. These plans often include coverage for ongoing preventive care, such as regular check-ups and screenings, that are part of your basic health needs. These can also help detect issues early to avoid more costly treatments down the line.

Supplemental vs. Comprehensive Medical and Dental Coverage

When deciding between supplemental and comprehensive medical and dental coverage, it's important to understand the differences and what each option offers. Comprehensive coverage is designed to provide extensive protection, covering a wide range of healthcare services, from routine check-ups to emergency care and major procedures. This is typically reserved for those who aren’t covered by provincial or territorial health insurance plans.

This plan typically includes all medical and dental insurance, ensuring that all your healthcare needs are met under one policy.

But most Canadian citizens and permanent residents have some form of government healthcare coverage. And a large portion of Canadians have additional insurance coverage through their employer. Supplemental coverage is designed to fill in the gaps or needs that may not be covered by your primary plans.

This could include additional benefits like vision care, extended drug coverage, or specific dental services not covered under your primary plans.

For example, one of the benefits of dental insurance is that it covers most basic preventative care. But a supplemental plan might provide additional coverage or higher coverage amounts for more complex treatments like fillings, crowns, and orthodontics, helping you avoid significant out-of-pocket expenses.

Supplemental plans are ideal for those who already have basic coverage but need extra protection for particular needs.

Prescription Drug Coverage in Medical and Dental Insurance Plans

Prescription drug coverage is a crucial component of Canadians' medical and dental insurance plans. The vast majority of Canadians don’t get prescription drug coverage from provincial or territorial plans. As medication costs continue to rise, insurance covering prescription drugs can significantly reduce out-of-pocket expenses.

Most comprehensive medical plans include prescription drug coverage, ensuring that you have access to necessary medications without facing financial strain. This coverage typically includes a wide range of prescription drugs, from common medications for chronic conditions to those needed for short-term illnesses.

For dental insurance plans, prescription drug coverage might also extend to medications related to dental procedures, such as antibiotics or pain management drugs following surgery. This added benefit ensures that your dental care is fully supported in the dentist's chair and during recovery.

By choosing a plan that includes robust prescription drug coverage, you can better manage your healthcare costs while ensuring you and your family can access the medications you need.

How to Purchase Medical and Dental Insurance

Purchasing medical and dental insurance doesn’t have to be complicated. With PolicyMe finding the right plan is a straightforward process that ensures you get the necessary coverage without any hassle.

Here's how you can secure the right plan:

Answer a Few Quick Questions: Provide basic information about your health and dental needs. PolicyMe will use this information to offer a personalized recommendation that fits your specific requirements and budget.
Review and Compare Plans: Within just 60 seconds, PolicyMe will provide a quote and allow you to compare three different plans. This quick and easy comparison helps you find the right coverage without any guesswork.
Choose Your Plan: After reviewing your options, select the plan that best suits your needs. PolicyMe makes it easy to choose the right plan with clear and straightforward choices.
Apply Online: Once you've selected your perfect plan, securing coverage is fast and hassle-free. The entire application process with PolicyMe takes less than five minutes, and medical questions aren’t required, making it convenient and efficient.
Get Assistance if Needed: If you prefer personalized guidance, you can speak with a PolicyMe advisor over the phone. This ensures you have all the information you need to make the best medical and dental insurance decision for you and your family.

How to File an Insurance Claim for Medical and Dental Care

Once you have your insurance plan, you’ll inevitably end up needing to file a claim.

Filing an insurance claim for medical and dental care might seem daunting, but it's typically a straightforward process if you know the steps.

Understanding how to properly file a claim ensures you receive the benefits you're entitled to without unnecessary delays. Here's a general process to help guide you through filing a claim:

Check Your Coverage: Before moving forward with any services, check your insurance policy to ensure the service or treatment you claim is covered. This step can help avoid surprises and clarify what portion of the costs your insurance will cover. Many providers can work with you to create a care plan that aligns with your coverage.
Gather Necessary Documentation: Before filing a claim, collect all relevant documents, including your insurance card, receipts, itemized bills, and any medical or dental reports. These documents are crucial for supporting your claim.
Complete the Claim Form: Obtain the necessary claim form from your insurance provider, online or by request. Fill out the form accurately, providing all required details such as your personal information, policy number, and specifics of the medical or dental service received. For some services and providers in Canada, the provider might be able to directly bill your insurance company, so you don’t have to wait for a reimbursement or file the claim yourself.
Submit the Claim: Submit your completed claim form and all supporting documentation to your insurance provider. Most insurance companies allow submissions online, by mail, or via email. Make sure to follow the submission guidelines provided by your insurer.
Follow-up: After submitting your claim, monitor its status by checking with your insurance provider. Some insurers offer online tracking, which allows you to see updates on the progress of your claim.
Receive Reimbursement: Once your claim is approved, your insurance provider will process the payment, either reimbursing you directly or paying the healthcare provider, depending on the specific claim.

Summary

Medical and dental insurance plans offer financial protection against high medical and dental costs, access to preventive care, and peace of mind, knowing you are covered for both routine and unexpected healthcare needs.
Comprehensive coverage is valuable for those who aren’t eligible for provincial or territorial healthcare plans. Supplementary coverage can help fill the gaps for those eligible for government coverage or who have health insurance through their employer.
Prescription drug coverage is essential to medical and dental insurance plans, helping reduce out-of-pocket costs for necessary medications.
You can compare and purchase the right medical and dental insurance plan through PolicyMe in as little as five minutes.

Can I have separate medical and dental insurance plans?

Yes, you can have separate medical and dental insurance plans. Medical insurance typically covers general healthcare needs, including prescription medications, extended healthcare, and paramedical services. In contrast, dental insurance covers dental care, such as cleanings, fillings, and other oral health services.

While you can purchase individual policies from different providers, it’s common for Canadians to purchase the packages together to save on costs and bundle services. But separate plans allow you to tailor your coverage to better meet your specific medical insurance needs so that you’re covering all your healthcare bases.

Are orthodontic treatments covered by dental insurance plans?

Orthodontic treatments, such as braces or aligners, are often covered by dental insurance plans, but the extent of coverage can vary widely. Some dental plans include orthodontic benefits as part of their standard coverage, while others may offer it as an optional rider that you can add for an additional premium. In some cases, orthodontic treatment can be limited to dependents under a certain age.

Coverage typically includes a percentage of the cost of treatment up to a certain maximum limit and may be subject to a waiting period before benefits become available. Reviewing your dental insurance plan's details is important to understand what orthodontic services are covered and any associated costs or limitations.

How does medical insurance handle specialist visits and treatments?

Medical insurance handles extends healthcare coverage beyond the basic coverage provided by provincial or territorial healthcare plans. Certain specialists, such as cardiologists or gynecologists, are typically covered by government healthcare plans. But medical insurance can cover paramedical services and specialists outside of these plans.

For example, medical insurance will often cover the cost of visiting a specialist, such as a registered dietitian or physiotherapist, or prescription drugs. In some cases, you may need a referral from your primary care physician, although some plans will allow you to go directly to the specialist. The specific coverage available will depend on your plan. In some cases, there may be maximums per year or appointment.

What is the waiting period for coverage to start with medical and dental insurance?

The waiting period for coverage to start with medical and dental insurance varies depending on the insurer and the specific plan. For medical insurance, many plans have no waiting period for basic coverage, meaning you can access benefits immediately upon enrollment.

Dental insurance plans often have waiting periods for major procedures like crowns or orthodontics, ranging from six months to a year. Or your coverage amounts might start lower in the first few years and scale up over time. Preventive care, such as cleanings and dental check-ups, might be covered immediately. It's important to check your plan's details to know when coverage begins for different services.

Are preventive care services included in both medical and dental insurance plans?

Yes, preventive care services are typically included in medical and dental insurance plans, though the specific services covered can differ. Medical insurance plans usually cover preventive services that aren’t covered by government healthcare plans to help keep you healthy.

Dental insurance plans often cover preventive services such as regular dental check-ups, cleanings, X-rays, and fluoride treatments. These preventive services are usually covered with little to no out-of-pocket cost, as they’re essential for maintaining overall health and preventing more serious conditions from developing. Reviewing your plan's benefits can help you understand the full scope of preventive care.

How does medical insurance cover chronic conditions and long-term treatments?

Medical insurance typically covers chronic conditions and long-term treatments by providing ongoing access to necessary healthcare services that aren’t available through government healthcare plans.

Coverage may vary depending on the plan, and it's important to ensure that your medical insurance adequately addresses the specific needs associated with long-term care. For example, if you have chronic pain that requires regular chiropractic visits, you may want to choose a plan with higher coverage for those services to minimize out-of-pocket costs.

Can family members be added to my existing medical and dental insurance plan?

Yes, family members can often be added to your existing medical and dental insurance plan, typically including your spouse and dependent children. The process for adding family members to your existing plan will vary from provider and may depend on your existing plan. In Canada, for the most part, you can add new plan members at any time.

While adding family members may increase your premium, it also provides coverage for your entire family under one policy, simplifying management and ensuring everyone has access to necessary healthcare services. It's important to check the specifics of your insurance plan to understand who can be added and any associated costs or coverage changes.