Dental services are one of the biggest expenses for many residents of Edmonton and Alberta in general. Unlike basic medical care, which is fully covered by the provincial AHCIP system, dental services are virtually not covered by the public health care system. This means that if you don't have private dental insurance, you will have to pay for most dental procedures out of your own pocket. However, the question of whether or not to purchase private dental insurance is not an easy one to answer, as it depends on many factors, including the type of procedures you may need, the cost of insurance, and your personal financial situation.
The question of dental insurance is particularly relevant for people who have just moved to Edmonton or who have families with children. Children often need dental care, including cleanings, fillings, and possibly braces. If you don't have insurance, the cost of these procedures can quickly add up. On the other hand, if you don't have serious dental problems, private insurance may be a waste of money.
This article will provide you with detailed information about what dental services are covered by private insurance in Edmonton, how dental insurance works, the cost of various procedures, what is covered and what is not covered, and how to determine whether you should purchase insurance.
How private dental insurance works
Private dental insurance in Edmonton typically works on a model called “100-80-50.” This model means that insurance covers 100 percent of the cost of preventive care, 80 percent of the cost of basic procedures, and 50 percent of the cost of major procedures. However, it is important to understand that this does not mean you never pay anything for preventive care. Many plans have a deductible, which means you have to pay a certain amount out of pocket before the insurance starts paying.
In addition, almost all plans have an annual maximum, which determines the maximum amount the insurance will pay during the year. This annual maximum is usually between $1,000 and $2,000, although some plans have a maximum of $3,000 or more. This means that once you reach this amount during the calendar year, your insurance will stop paying for any further dental services until the beginning of the next year. Anything you spend after reaching the annual maximum will be entirely at your expense.
The cost of private dental insurance in Edmonton varies depending on the level of coverage you choose. A basic plan that covers preventive care and some basic procedures can cost between $20 and $40 per month. A more comprehensive plan that covers preventive care, basic procedures, and major procedures can cost anywhere from $40 to $80 per month or even more. Some plans also include coverage for orthodontic services, such as braces, which can further increase the cost of insurance.
What is covered by private dental insurance
Private dental insurance covers a wide range of services, but it is important to understand that not all services are covered equally.
Preventive care covered 100 percent
Preventive care includes services that are designed to prevent dental problems. These services are usually covered 100 percent by private insurance, which means that the insurance pays the entire cost of these services and you do not have to pay anything out of pocket, except for the deductible, if applicable.
Preventive care includes regular dental checkups, which are usually performed every six months. During the exam, the dentist looks at your teeth and gums to check for signs of tooth decay, gum disease, or other problems. Preventive care also includes professional teeth cleaning, which removes plaque and tartar from your teeth and under your gums. In addition to cleaning, the dentist may also apply fluoride to strengthen your tooth enamel.
Preventive care also includes dental X-rays. X-rays allow the dentist to see problems that are not visible to the eye, such as cavities between teeth or bone disease. Regular X-rays help detect problems in their early stages, when they are much cheaper and easier to treat.
Basic procedures covered at 80 percent
Basic procedures include services that are necessary to treat dental problems that have already developed. These services are usually covered at 80 percent by private insurance, which means that the insurance pays 80 percent of the cost and you pay the remaining 20 percent.
Basic procedures include dental fillings. Fillings are used to fill a hole in a tooth caused by tooth decay. The cost of a filling depends on the size and material of the filling. Composite fillings, which match the color of your natural tooth, cost between $138 and $432 in Edmonton, depending on how many surfaces of the tooth need to be filled. Amalgam fillings, which are cheaper but have a silver color, may cost slightly less.
Basic procedures also include tooth extractions. A simple tooth extraction that does not require surgery costs between $160 and $290 in Edmonton. If the tooth requires surgical removal, such as wisdom tooth extraction, the cost can be significantly higher. Wisdom tooth removal can cost between $400 and $1,000 or more, depending on the complexity of the procedure.
Basic procedures also include teeth cleaning for people with gum disease. Unlike regular teeth cleaning, which is covered 100 percent, special cleaning for gum disease, called scaling and root planing, is covered 80 percent. This procedure is more thorough than regular cleaning and is designed to remove bacteria and inflammation from under the gums.
Basic procedures also include root canals. A root canal is a procedure that removes infected or dead pulp from the inside of a tooth. The cost of a root canal depends on how many canals need to be treated, but it usually costs between $761 and $1,637 in Edmonton.
Major procedures covered at 50 percent
Major procedures include services that are expensive and often long-term. These services are usually only covered at 50 percent by private insurance, which means that insurance pays half the cost and you pay the other half.
Major procedures include crowns, which are often used to protect a weakened tooth or to replace a large filling. A crown is usually made of porcelain and metal and covers the entire visible tooth. The cost of a crown in Edmonton is typically between $950 and $1,165, plus a lab fee of $400 to $600, which is paid to the dental lab for making the crown.
Basic procedures also include bridges. A bridge is an artificial tooth that is held in place by crowns on adjacent teeth. Crowns for a bridge cost the same as regular crowns, but a bridge can have several artificial teeth, so the cost can be significantly higher.
Basic procedures also include full and partial dentures. A denture is a removable prosthesis that replaces some or all of your natural teeth. Dentures require specialized fabrication by a dental technician, and the cost depends on the number of teeth that need to be replaced and the quality of the material. Full dentures can cost anywhere from $1,000 to $4,000 or more.
Basic procedures also include dental implants. A dental implant is an artificial tooth root that is implanted into the jawbone and then covered with a crown. The total cost of an implant, including surgery and crown, is typically between $3,000 and $6,000 or more in Edmonton. However, many insurance plans do not cover implants at all, or cover them at a significantly lower rate.
What is not covered by private dental insurance
Private dental insurance has many exclusions and limitations that are important to understand before purchasing a plan.
Cosmetic procedures
Most dental insurance plans do not cover cosmetic procedures such as teeth whitening, tooth surface correction, or veneers. These procedures are considered elective because they are not necessary for gum and tooth health. However, some cosmetic procedures may have some health benefits, such as teeth straightening, which can reduce stress on the jaw and lower the risk of gum disease. In these cases, some plans may cover part of the cost.
Orthodontic Services
Orthodontic services, such as braces or aligners to straighten teeth, are not covered by most basic dental insurance plans. However, some plans offer a separate maximum for orthodontic services, typically ranging from $1,500 to $3,000. If your plan covers orthodontic services, there is often a waiting period of two to three years before the insurance will begin to pay for these services.
Pre-existing conditions
Many dental insurance plans have exclusions for pre-existing conditions. This means that if you had a dental problem before you purchased insurance, the insurance may not cover treatment for that problem for a certain period of time, often six months to a year.
Experimental or investigational procedures
Plans do not cover experimental or investigational procedures that have not yet been proven effective.
Waiting Period in Dental Insurance
Many dental insurance plans have a waiting period, which means that you cannot use your insurance for certain procedures for a certain amount of time after purchasing the plan. The waiting period is designed to prevent people from purchasing insurance solely to cover an expensive procedure that they already know they will need.
Typically, there is no waiting period for preventive care, such as checkups and cleanings. The waiting period for basic procedures, such as fillings, is often three to six months. The waiting period for major procedures, such as crowns, bridges, and dentures, is often six to twelve months. Some plans have even longer waiting periods for major procedures, often twenty-four months.
Deductible and annual maximum
In addition to the waiting period, it is important to understand your plan's deductible and annual maximum.
A deductible is the amount of money you must pay out of pocket before your insurance begins to pay. A typical deductible in a dental insurance plan is between $50 and $100 per year. Some plans have separate deductibles for different types of services, such as a deductible for preventive care and a separate deductible for basic and major procedures.
The annual maximum is the maximum amount that the insurance will pay during the year. As mentioned earlier, a typical annual maximum is between $1,000 and $2,000, although some plans have a maximum of $3,000 or more. It is important to understand that the annual maximum does not usually include preventive care, which is often covered separately. This means that preventive care does not count toward your annual maximum.
Cost of dental procedures in Edmonton
In order to determine whether private insurance is right for you, it is important to know how much dental services cost in Edmonton.
A regular checkup and cleaning costs between $150 and $160. Since this procedure is covered 100 percent by most plans, you pay nothing out of pocket unless you have a deductible.
Dental X-rays cost between $35 and $107, depending on the type of X-ray. These X-rays are also usually covered 100 percent.
A single tooth filling costs between $138 and $432, depending on the size and material. Since fillings are covered at 80 percent, you pay 20 percent of the cost out of pocket.
A simple tooth extraction costs between $160 and $290. With 80 percent coverage, you pay between $32 and $58.
A root canal costs between $761 and $1,637, depending on the number of canals. With 80 percent coverage, you pay between $152 and $327.
A crown costs between $950 and $1,165, plus a lab fee of $400 to $600. With 50% coverage, you pay between $675 and $883.
A denture costs between $1,000 and $4,000 or more. With 50% coverage, you pay between $500 and $2,000 or more.
A dental implant costs between $2,400 and $6,000 or more, depending on the complexity. Many plans do not cover implants at all.
How to determine if private dental insurance is right for you
When considering whether to purchase private dental insurance, you need to assess your personal situation and determine if the insurance will pay off in the long run.
If you are a young person with no dental problems and who does not think you will need any major dental work for at least a year, private insurance may not be worth it for you. However, if you have children or need major dental work, insurance may be worth it.
Let's look at an example. Suppose the cost of the insurance plan is $50 per month, or $600 per year. During the year, you have one exam and cleaning for $150, and then you need one filling for $300. The cost without insurance is $450. With insurance, you pay a $50 deductible for the exam and cleaning, and then $60 for 20 percent of the cost of the filling. Your total cost with insurance is $110 plus $600 for insurance, for a total of $710. In this case, insurance does not pay off.
However, if you have more work done. Let's say you have the same exam and cleaning, filling, but you also need a root canal and a crown. The cost without insurance is $150 + $300 + $900 + $1,050 = $2,400. With insurance, you pay $50 for the exam and cleaning, $60 for the filling, $180 for the root canal, $525 for the crown, plus $600 for insurance, for a total of $1,415. In this case, the insurance pays for itself.
Another factor to consider is whether you have access to group insurance through your employer. Group plans are often cheaper than individual plans, so if you have access to a group plan, it is worth taking advantage of it.
Alternatives to private dental insurance
If you feel that private insurance is too expensive or not worth it, there are several alternatives you can consider.
Canadian Dental Care Plan federal program
The Canadian federal program Canadian Dental Care Plan (CDCP) provides subsidized dental care to low- and moderate-income individuals. If you qualify for this program based on your household income, you can receive comprehensive coverage for dental care without having to purchase private insurance.
Provincial Assistance Programs
Alberta has several provincial programs that provide dental assistance to low-income individuals and seniors. The Dental and Optical Assistance for Seniors program provides up to $5,000 to cover dental and optical care for low-income individuals over the age of 65.
Personal payment plans
Many dental clinics offer personal payment plans that allow you to spread the cost of dental work over several payments over time. This can make large procedures more financially manageable without the need to purchase insurance.
Student insurance
If you are a student, your college or university may offer group insurance for students that includes dental coverage.
Conclusion: The decision depends on your situation
The final answer to the question of whether private insurance covers dental services in Edmonton is yes. However, the question of whether you should purchase private insurance depends on your personal situation. If you have children, require regular dental care, or anticipate needing major dental work, private insurance may be worth the cost. If you are a young person without dental problems, you may simply want to set aside money for dental expenses or consider alternatives such as personal payment plans or provincial assistance programs.
Before purchasing a plan, it is important to read the fine print and understand what services are covered, to what extent they are covered, whether there are waiting periods, and what the deductible and annual maximum are. You should also compare several different plans and providers to find the best plan for your needs and budget. If you have access to group insurance through your employer, be sure to take advantage of it, as group plans are usually cheaper and more comprehensive than individual plans.