Yes, braces are covered by most dental insurance plans in Canada. Most private insurance plans cover 50% to 80% of orthodontic costs up to lifetime maximums of $2,000 to $5,000 per person. However, many plans only cover patients under 18 years old.
The Canadian Dental Care Plan (CDCP) will start covering some orthodontic services in 2025, but only for severe medical cases.
What's New in 2025: CDCP Orthodontic Coverage
Starting in 2025, the CDCP will cover orthodontic treatments for the first time, according to Canada’s official dental care website. This coverage has strict limitations:
- Only for severe medical cases, not cosmetic improvements
- Children under 18 with severe bite problems
- Adults with birth defects like cleft lip and palate
- Requires pre-approval before treatment starts
Most families will still need private insurance or payment plans for regular orthodontic care.
How Much Do Braces Cost in Canada?
Understanding real costs helps you plan your budget:
Traditional Metal Braces:
- Total cost: $3,000-$7,000
- With 50% insurance: $1,500-$3,500 out of pocket
Ceramic or Clear Braces:
- Total cost: $4,000-$8,000
- With 50% insurance: $2,000-$4,000 out of pocket
Invisalign:
- Total cost: $6,000-$10,000
- Insurance coverage varies significantly
Types of Insurance That Cover Braces
Employer Benefits (Most Common)
- Cover 50% to 80% of treatment costs
- Lifetime maximums of $2,000-$5,000 per person
- Often limited to children under 18
- May have 6-12 month waiting periods
Private Insurance
Sun Life and Manulife offer orthodontic coverage through specific plans, according to Sun Life’s dental insurance information. Private plans typically cost more and have longer waiting periods.
What’s Not Covered
- OHIP does not cover braces (considered elective)
- Most provincial health plans have no orthodontic coverage
- Purely cosmetic treatments
Common Coverage Limitations
Age Limits: Many plans stop covering orthodontics after age 18.
Waiting Periods: New insurance often requires waiting 6-12 months before orthodontic benefits begin.
Lifetime Maximums: Once you reach your maximum (typically $2,000-$5,000), you pay 100% of remaining costs.
Pre-existing Conditions: Problems that existed before getting insurance may not be covered.
How Insurance Actually Works
The process is straightforward:
- Consultation: Orthodontist examines and creates treatment plan
- Pre-Authorization: Submit treatment plan to insurance for approval
- Treatment Begins: Pay your portion, insurance covers their percentage
- Ongoing Claims: Regular appointments are submitted for reimbursement
Most patients pay upfront and receive insurance reimbursement afterward.
What If Insurance Doesn't Cover Everything?
Payment Plans
Most orthodontic offices offer interest-free financing options. Monthly payments can make treatment affordable even without insurance.
Canadian Tax Benefits
You can claim orthodontic expenses as medical tax credits through the Canada Revenue Agency. This typically provides 15% of eligible expenses back on your tax return.
Health Spending Accounts
Many employers offer HSAs where you can use pre-tax dollars for orthodontic treatment not covered by insurance.
Key Questions to Ask Your Insurance
- What percentage do you cover for orthodontics?
- What’s my lifetime maximum benefit?
- Is there an age limit for coverage?
- Do I need pre-approval before starting treatment?
- Are all types of braces covered equally?
When Should You Start Planning?
Early Evaluation: Children should have orthodontic evaluation by age 7. Early treatment is often simpler and less expensive.
Insurance Timing: If you’re planning treatment, get insurance coverage 12 months ahead to satisfy waiting periods.
Don’t Wait: Delaying treatment for better coverage often makes problems more complex and expensive to treat later.
The Bottom Line
Most Canadians need private dental insurance for orthodontic coverage. Even with good insurance, expect to pay $1,500-$4,000 out of pocket for braces.
The new CDCP coverage in 2025 will help some families, but most orthodontic treatment will still require private insurance or payment plans.
At Oasis Orthodontics in Markham, Dr. Sharma-Fung helps families navigate insurance coverage and understand their exact benefits before treatment begins. We offer interest-free financing options that make orthodontic care affordable, even when insurance coverage is limited.
Planning ahead and understanding your specific coverage prevents financial surprises and helps you get the treatment you need.