The Ontario Health Insurance Plan (OHIP) doesn’t cover routine dental exams, cleanings, fillings or crowns – only certain oral surgeries performed in a hospital. Without coverage, even basic preventive care can strain a household budget. Dental insurance offsets these costs and encourages regular check‑ups. Studies show people without insurance are more likely to skip dental visits, increasing their risk of untreated decay and gum disease.

Government programs

Several publicly funded programs offer dental care to specific groups:

• Canadian Dental Care Plan (CDCP) – A federally sponsored program for Canadians with an adjusted family net income under $90 000 who don’t have private coverage. It covers exams, cleanings, fillings, root canals, extractions, periodontal care and dentures. Coverage is income‑based: families earning under $70 000 receive 100 % coverage; those between $70 000 and $79 999 receive 60 % coverage; and those between $80 000 and $89 999 receive 40 %. Implants, orthodontics and cosmetic procedures are excluded. Dentists must register with CDCP to bill the plan. If you have private insurance, you aren’t eligible.

• Healthy Smiles Ontario (HSO) – A provincial program providing free preventive, routine and emergency dental services for children and youth 17 and under from low‑income families. Coverage includes check‑ups, cleanings, fillings, X‑rays, scaling and extractions. Cosmetic dentistry and braces aren’t covered.

• Ontario Seniors Dental Care Program (OSDCP) – Offers free routine dental services to seniors 65 and older with annual incomes below $25 000 (single) or $41 500 (couple) and no private coverage. It covers check‑ups, scaling, fillings, extractions, root canals and periodontal care. Dentures are partially covered. Coverage ends every July 31 regardless of enrollment date.

Public programs are valuable if you qualify, but many people don’t meet the income thresholds or need services they don’t cover. That’s where private dental insurance comes in.

Private dental insurance and what it covers

Private plans are offered by insurers like PolicyMe, GreenShield, Manulife, GMS, Sun Life, Canada Life, Pacific Blue Cross and GreenShield. Most plans group treatments into tiers:

1. Preventive care – Exams, X‑rays and cleanings are usually covered at a high percentage because they help prevent larger issues.

2. Basic services – Fillings, extractions and root planing are reimbursed at 70-90 % depending on the plan.

3. Major services – Crowns, bridges, dentures and oral surgery are covered at a lower percentage and may have waiting periods.

4. Orthodontics – Braces and aligners are included only in enhanced plans and often have lifetime maximums.

Each insurer offers different packages. At Dr. Salim Kapadia Dental Centre in Scarborough, we accept all major private dental plans. Whether you’re insured through your employer or have purchased coverage yourself, our team can provide estimates, direct bills where possible and help you understand your benefits.