Private Health and Dental Insurance in Canada: What It Covers
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Private health and dental insurance pays for the care your provincial health plan leaves out. Your province covers medically necessary doctor and hospital services, but many Canadians still pay out of pocket for dental cleanings, prescription drugs taken at home, eyeglasses, and services like physiotherapy. This guide explains how private health and dental insurance works in Canada, the difference between group and individual plans, and how the federal Canadian Dental Care Plan (CDCP) and Quebec's public prescription drug insurance fit in, as of October 20, 2026. For other coverage, browse our insurance guides.
The right choice depends on three things: whether you have access to a workplace plan, your family income, and the province you live in. Each one changes what you can buy and what the government pays.
What private health insurance covers
Private health and dental plans, often called extended health care, reimburse part of the costs that provincial plans do not pay. The exact list depends on the plan you choose, but the main categories are similar from one insurer to another.
- Prescription drugs: medications you fill at a pharmacy, up to the plan's limits and drug list.
- Dental care: exams, cleanings, fillings, and sometimes major work such as crowns or dentures.
- Vision care: eye exams, glasses, and contact lenses, usually with a fixed amount per period.
- Paramedical services: physiotherapy, massage therapy, chiropractic care, psychology, and similar practitioners.
- Other services: ambulance, medical equipment, and private or semi-private hospital rooms.
Plans usually reimburse a percentage of each claim, up to an annual or per-service maximum. Read the schedule of benefits to see the percentage, the yearly cap, and any waiting period before major dental work is covered.
Group plans vs individual plans
Many Canadians get private coverage through work. If you do not, you can buy an individual plan directly from an insurer.
Group plans through work
A group plan is part of your employer's benefits. The employer picks the insurer and the coverage, and often pays part or all of the premium. Group plans usually accept all eligible employees without health questions, which matters if you take regular medication.
Some employers add a health spending account, which reimburses eligible medical expenses up to a set amount each year. Learn more in our guide to health care savings accounts.
Individual plans you buy
An individual plan is a contract between you and the insurer. You choose the level of coverage and pay the full premium. The main insurers that sell individual plans in Canada include:
- Blue Cross: sold through regional organizations, such as Québec Blue Cross for Quebec residents.
- Manulife: Flexcare plans, plus FollowMe plans for people whose group benefits are ending.
- Sun Life: Personal Health Insurance and Health Coverage Choice.
- GreenShield: ZONE and LINK plans, sorted into guaranteed acceptance and health questionnaire categories.
Some individual plans ask about your health and can refuse you or exclude conditions. Others offer guaranteed acceptance with no medical questions, sometimes with fewer benefits or lower limits. Insurers do not all publish their prices; most ask for your age, province, and coverage level before they give you a quote.
Leaving a group plan
The window after your group benefits end is the best time to buy individual coverage. Several insurers waive medical questions if you apply quickly, so do not let it pass.
As of October 20, 2026, insurers publish these windows:
- Manulife FollowMe: acceptance is guaranteed with no medical questions if you apply and pay your first premium within 90 days of your employee benefits ending. Dental coverage is included only in the EnhancedPlus and Premiere plans.
- Sun Life Health Coverage Choice: no medical requirements if you apply within 60 days of losing an employer plan; applicants must be 74 or younger.
- Sun Life Personal Health Insurance: asks about your health, and applicants must be 69 or younger.
Sun Life warns that if you apply for Personal Health Insurance and are refused, you can no longer apply for Health Coverage Choice. Check the conversion options in your own group booklet as well, since some plans offer their own path.
The Canadian Dental Care Plan in 2026
The Canadian Dental Care Plan (CDCP) is the federal program for people who do not have access to dental insurance. The plan opened in stages, and since May 2025 the remaining eligible adults aged 18 to 64 can apply too, so every eligible age group now has access.
Who qualifies
As of October 20, 2026, the Government of Canada lists four conditions:
- No access to dental insurance: no coverage through your job, a family member's job, a pension plan, a professional or student association, or a plan you buy yourself.
- Tax return filed: you, and your spouse or common-law partner if you have one, filed your tax return in Canada.
- Income: your adjusted family net income is less than $90,000.
- Residency: you are a Canadian resident for tax purposes.
Access is the key word. You are excluded even if you never used your workplace dental plan, chose not to enrol, or would have to pay a premium for it. A health spending account that covers dental costs also counts as access. However, coverage through a provincial, territorial, or federal government social program does not disqualify you.
What it covers and what you pay
The CDCP covers preventive care, such as exams, X-rays, and cleanings, as well as basic and major services such as fillings, root canals, dentures, and extractions. Some services require preauthorization. Depending on your adjusted family net income, you pay a co-payment based on the CDCP fee grid.
| Adjusted family net income | Your co-payment | What the CDCP pays |
|---|---|---|
| Under $70,000 | 0% of CDCP fees | 100% of CDCP fees |
| $70,000 to $79,999 | 40% of CDCP fees | 60% of CDCP fees |
| $80,000 to $89,999 | 60% of CDCP fees | 40% of CDCP fees |
| $90,000 or more | Not eligible | Nothing |
Applications for the 2026-2027 benefit period are open. Members must renew every year during the renewal period; the renewal for the 2025-2026 period closed in June 2026. If you miss it, you can submit a new application, but care received during the gap is not covered.
Quebec: drug insurance is mandatory
In Quebec, prescription drug insurance is compulsory. According to the RAMQ, anyone who lives in Quebec permanently must be covered. If you are eligible for a private group plan, you must join it and cover your spouse and children. Otherwise, you must register with the public plan run by the RAMQ.
At 65, your registration with the public plan is automatic. If you also have access to a private plan, you can choose the public plan only, the private plan only, or both. In practice, a Quebec worker cannot decline the drug coverage in a group plan and switch to the public plan to save money.
The public plan has its own costs. For the period from July 1, 2026, to June 30, 2027, the RAMQ sets these amounts:
- Annual premium: between $0 and $789 per person, paid through your Quebec tax return and based on net family income.
- Monthly deductible: $21.25 on your first purchases each month.
- Coinsurance: 30% of the cost of covered drugs once the deductible is paid.
- Maximum contribution: $105.25 per month and $1,263 per year.
Some people pay less. The maximum drops to $58.08 per month ($697 per year) for people aged 65 or over who receive less than 94% of the maximum Guaranteed Income Supplement, and those who receive 94% or more are covered free of charge, as are children under 18 of people covered by the public plan who have no access to a private plan.
The RAMQ also pays for some dental care for children under 10, including annual exams, X-rays, fillings, and extractions done by a dentist. Adults in Quebec need private insurance, the CDCP, or their own savings for routine dental care.
Taxes on health insurance premiums
You can claim premiums you pay for a private health services plan as a medical expense on your tax return, as long as 90% or more of the premiums are for eligible medical expenses, according to the CRA's medical expenses guide. You cannot claim premiums your employer paid that were not included in your income.
The medical expense credit only applies to expenses above a threshold based on your net income, so it helps most when your total medical costs are high. Self-employed people may be able to deduct the premiums as a business expense instead, under CRA conditions, but the same premium cannot be claimed twice. Our income tax calculator helps you estimate your tax position.
How to choose a plan
Start by listing what you spent on drugs, dental care, glasses, and therapy last year. Then compare that total with the annual premium and the coverage limits of each plan.
- Check the CDCP first: if you have no access to dental insurance and your adjusted family net income is under $90,000, the federal plan may cover routine care.
- Compare the reimbursement rate: the percentage the plan pays on each claim, by category.
- Read the annual maximums: the yearly cap for dental, vision, and paramedical services.
- Look at the drug coverage: which medications are covered and whether there is an annual limit.
- Check the waiting periods: some plans delay coverage for major dental work.
- Confirm the acceptance rules: guaranteed acceptance or medical questions, and any exclusions.
- In Quebec, start with your obligation: join your group plan if you have access to one, otherwise register with the RAMQ.
Conclusion
Private health and dental insurance is worth it when your expected claims, plus the value of protection against a large bill, exceed the premium. If you have a workplace plan, it is usually the best deal, since the employer pays part of the cost. If you do not, check the CDCP first, then compare individual plans, and move fast when a group plan ends.
In Quebec, remember that drug coverage is not optional: you either join your group plan or register with the RAMQ. For related protection, read our guide to travel insurance and health coverage, or compare products on our insurance comparison page.
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Frequently asked questions about health and dental insurance
Is private health insurance worth it in Canada?
It depends on your expected costs. If you take regular medication, need dental work, or use services like physiotherapy, a plan can pay for itself, especially through an employer that shares the premium. If you are healthy and have savings, you may prefer to pay small bills yourself and keep an emergency fund. Our emergency fund calculator helps you size that cushion before you decide.
Can I get the Canadian Dental Care Plan if I have dental insurance through my spouse?
No. The CDCP excludes anyone with access to private dental coverage, including coverage through a family member's job or pension plan. This applies even if you never use it or decided not to enrol. Coverage through a government social program, such as a provincial program for low-income families, does not disqualify you. See our insurance hub for other ways to cover dental costs.
How much does the Canadian Dental Care Plan cost?
There is no premium and no fee to apply or renew. Instead, you pay a co-payment at the dentist: 0%, 40%, or 60% of the CDCP fees, depending on your adjusted family net income, as the table above shows. Ask your dentist before treatment whether any part of the bill falls outside the CDCP. Our take-home pay calculator can help you understand your income picture.
Do I have to join my employer's drug plan in Quebec?
Generally, yes. Under Quebec's rules, if you are eligible for a private group plan, you must join it and cover your spouse and children. You can only register with the RAMQ's public plan if you have no access to a private plan, if you are 65 or over, or if you receive financial assistance with a claim slip. Read the RAMQ's eligibility page and our insurance guides for more context.
What happens to my health coverage when I leave my job?
Your group coverage usually ends on your last day or soon after. Several insurers offer guaranteed acceptance if you apply quickly: Manulife's FollowMe plans within 90 days, and Sun Life's Health Coverage Choice within 60 days. After that, you may need to answer medical questions and could be refused or have conditions excluded. Our guide to Sun Life insurance covers the insurer's other products.
Are health insurance premiums tax deductible?
Premiums you pay yourself for a private health services plan can be claimed as a medical expense, as long as 90% or more of the premiums are for eligible medical expenses. The credit only applies above a threshold based on your income. Self-employed people may deduct the premiums as a business expense instead, under CRA conditions. See our business finance guides for more on deductions.
Does provincial health insurance cover prescription drugs?
Drugs given in hospital are covered by your province. Outside the hospital, each province runs its own drug programs, and the rules vary widely. In Quebec, every resident must have drug coverage, through a private group plan or the RAMQ public plan. Check your province's program before you buy a private plan, and compare options on our insurance comparison page.
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