Orthodontics
Orthodontics covers the cost of correcting tooth alignment and jaw positioning using braces or aligners. In individual and group dental plans, orthodontic benefits are usually separate from preventive and restorative coverage. Most plans apply a lifetime maximum and a waiting period before orthodontic treatment is eligible.
How It Works
Because orthodontic benefits sit apart from preventive and restorative coverage, a dental plan handles them under their own rules. Plans typically apply a lifetime maximum and a waiting period before treatment becomes eligible, and many add an age restriction that limits coverage to dependents under a set age. The portion a plan pays is shaped by these limits together, including annual or lifetime maximums, coinsurance percentages, age-based eligibility rules, and waiting periods, which is why a plan often covers only part of a braces bill. Separately from any plan, the CRA treats orthodontic work as a dental service under paragraph 118.2(2)(a) of the Income Tax Act and lists it, including braces, as an eligible medical expense. Both traditional metal braces and clear aligners like Invisalign can qualify when prescribed by a licensed dentist or orthodontist for medical rather than cosmetic reasons. The CRA medical-expense rule carries no orthodontic-specific age cutoff, so adults can claim treatment for themselves and dependants can be covered when the tax rules and the plan allow it.
Example:
Suppose your child needs braces and your Canadian group dental plan includes orthodontic coverage at half of eligible costs up to a lifetime maximum. Once any waiting period has passed, the plan reimburses that share of the eligible treatment until the lifetime maximum is reached, and you cover the remainder. If the plan does not pay the full bill, you may be able to put the unreimbursed eligible portion through a Health Spending Account, since the CRA lists orthodontic work including braces as an eligible medical expense.
What to Watch For:
Read the orthodontic limits closely before you start treatment. A plan can pay only part of a braces bill once you account for annual or lifetime maximums, coinsurance percentages, age-based eligibility rules, and waiting periods, so confirm the age restriction, since coverage is commonly limited to dependents under a set age, and check the waiting period before treatment is eligible. Keep in mind that orthodontic benefits are usually separate from preventive and restorative coverage, so the way one part of your plan pays does not tell you how the orthodontic portion will.
