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Your Essential Guide to Ontario Dental Insurance Options

on 27 Oct, 2018

Hands up if you’re afraid of the dentist.

If you struggle with Dentophobia, you’re not alone. Many people fear dentists and feel anxious about sitting in that dreaded chair. But these days, the fear of dentists is coupled with a growing fear: the price of their fees.

Even if you don’t have Dentophobia when you have a toothache, do you sometimes think twice about seeing a dentist?

If you do, remember, your dental health is a critical part of your overall health and you deserve access to appropriate dental health care.

The answer to this mounting fear of dentist’s fees is dental health insurance.

Luckily, understanding dental insurance is a breeze compared to medical insurance. Most policies offer a specific, straightforward explanation of what is covered and exactly what is required of you.

Please read on to find out more about Ontario dental insurance benefits and how dental policies can work best for you.

The Situation in Canada

In Canada, the government offers universal health care coverage for all citizens.

Well, pretty much.

At the moment, Medicare covers roughly 70% of medical costs. What this means for you is that you’re still responsible for the costs relating to prescription drugs, vision and dental.

Due to this, a large portion of Canadians invest in private supplementary medical insurance, allowing them coverage on the issues Medicare leaves out.

Other perks of private medical insurance include having the choice to see a private doctor or dentist closer to you and the option of having health issues tackled quicker.

Dental insurance benefits are also easy to explain and grasp. Simply, they help many people effectively budget for the cost of maintaining their dental health.

The level of coverage you choose will ascertain which procedures are included and which are subject to extra pay. Dental insurance is available as part of either a medical insurance plan or as a standalone policy.

Oral Health Awareness

The Canada Health Act (CHA) does not include general oral health care.

Oral healthcare is therefore mainly accessed through privately operated dental clinics and paid for through insurance.

There are some dental services covered by government dental programs, which are critical to the health of Canadians who live on the poverty line.

In Canada, April is oral health month. Throughout the country, ads remind people of the ‘dentist benefit’ and to make dentist appointments for regular check-ups.

But in Canada’s private dental care system, you have to pay to access both dentists and oral hygienists.

So you say, what if I can’t afford to see a dentist or dental hygienist? Well, rest assured, you’re not alone.

Figures show that about one in six Canadians have difficulty accessing oral health care because it’s just too expensive.

It’s estimated that in Ontario, two to three million people have not seen a dentist in the past year, with the main reason being cost.

The only public dental programs in Ontario are for children under 18 and for very low-income families. But there are no dental health provincial programs for low-income adults or seniors.

Dental Health is NB

Many vulnerable people cannot afford access to dental care and subsequently, have the highest rates of tooth decay, gum disease and related pain.

Oral diseases affect a person’s general health and overall well-being.

Furthermore, there is a link between poor oral health and the severity of chronic illness, such as diabetes, cardiovascular and respiratory diseases. The dental health benefit is therefore far wider reaching than just oral health.

Oral diseases and missing teeth also have an impact on a person’s sense of self-worth and their ability to access employment. It’s difficult to look for a job while experiencing dental pain or if you’re missing visible teeth.

So what’s happening then, if people are experiencing dental problems but can’t afford to see a dentist?

In many cases, people are turning to their family doctors in the hope of getting assistance from them. Some will even try to treat the pain themselves or will look into black market dentists who are unqualified.

Family Doctors Don’t Know Teeth

In 2014, there were almost 222,000 visits to Ontario physicians for teeth and gum problems.

The issue with this is that physicians aren’t equipped or trained to deal with teeth and gum diseases.

Family doctors cannot provide appropriate treatment for these ailments and so a patient will end up wasting their time and money on an appointment like this.

The Ontario Health Insurance Plan (OHIP) pays doctors a minimum of $33.70 per 15-minute patient consultation. In all, these consultations added up to around $7.5 million of additional costs for Ontario’s health care system in 2014.

Importantly, the patients received no proper treatment for the underlying health issue. This is clearly a waste of healthcare resources, public funds and physicians’ valuable time.

Understanding Ontario Dental Insurance

Many private dentists admit they are frustrated when people who cannot afford appointments will miss them and take away valuable appointment time from others.

Along with this, research shows that many people living on low income prefer to be treated in public dental clinics where they believe they are less likely to experience stigma.

These issues show a growing need for affordable and customizable dental health insurance that allows people the dignity of access to the care they need.

If people don’t understand the benefit of dental insurance, they will continue to take ‘short cuts’ in attempts to save money.

Unfortunately, these “shortcuts” often result in more money and time being wasted. This isn’t the way to move forward.

Every day you use your teeth for talking, chewing and smiling. So, maintaining strong and healthy teeth is a necessity for everyone.

Dental insurance plans can help defray the costs of treatment, but it can be tricky to navigate what’s covered and what’s not. In other words, how do you make the most of a dental plan?

Keep reading to find out.

Welcome to the network

Most dentists operate under a Preferred provider organization (PPO) agreement.

What this means is that your health insurance provider has an agreement with certain dentists in your area. This negotiation secures lower rates for service.

These dentists are known to be ‘in your network’ and will bill your individual plan directly.

If you choose to go outside of a PPO network, you will often pay a lot more and will have to submit the paperwork in your own time.

What Dental Insurance Covers

While not all dental plans are created equal, a standard PPO will usually cover 80 to 100 percent of the costs of treatments like checkups, fluoride, sealants and cleanings.

Root canals, fillings and other more critical work will be covered by plans in the range of 70 to 80 percent. While major treatments like dentures and crowns will typically be covered by about 50 percent.

Keep in mind that treatments vary greatly in cost.

A periodic oral exam costs less than $100, while a new crown can cost $800. Fixing a molar costs at least $600 and as a result, your plan will end up working hard to assist your financial needs.

More expensive options

Typically, dental insurance plans have ‘tiers’ or levels of coverage.

Basic options are meant to cover the expenses linked with hygiene. You can also opt for orthodontic coverage, which includes expensive options like casts, braces and referrals to orthodontic specialists.

Some Important things to keep in mind when thinking about dental health insurance include the following.

Know your Dental Plan’s Benefit Period

Before taking into account your remaining benefits, you should be aware of when your plan’s coverage ends.

While most providers will follow the normal calendar year, don’t assume that yours does.

Most plans will have a one-year benefit period but may differ in starting and end points. In order to get the most out of your dental insurance plan, find out the specific time frame of your coverage and plan your dental care accordingly.

Make the Most of Benefits

Preventative care is an important focal point of dental plans. Plans will completely cover regular check-ups and teeth cleanings.

Often, patients will forget about their preventative benefits and let them go unused. Regular visits and cleanings greatly benefit oral health and will save you money in the long run.

Of course, every dental insurance is different. Make sure you carefully look at your plan details, so you can take full advantage of your benefits.

Deductible Decisions

Everyone has a deductible, which is the amount you have to pay out-of-pocket before your dental plan starts covering the agreed upon amount.

To make the most out of your coverage, you’ll want to roll as many services you can into one visit, so you only pay a single deductible.

Of course, you can only do this within reason and most dentists will see to most of your dental needs in a relatively short time anyway. This saves you money in the long run.

If you’re close to meeting your deductible for the year, it may be a good time to think about the more costly dental work you’ve been avoiding. This will lower your out-of-pocket cost for dental procedures before your deductible starts again in the new year.

Everyone Deserves a Healthy Mouth

So, fast-forward to the next oral health awareness month in April – I hope you’ll have chosen to think more about your dental health needs. Talk to your friends and family about ensuring they are covered with a plan that suits them.

At the end of the day, no matter our budget or lifestyle, we all deserve a healthy mouth and smile.

Understanding Ontario dental insurance options is a key factor on this journey to improved dental health and overall wellness.

We’re more than happy to explain why dental insurance helps benefit dental health. Please feel free to contact us about the best dental health insurance for your specific needs.

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