What Does Dental Insurance Actually Cover in 2026?
Most plans cover cleanings and X-rays — but the details on fillings, crowns, and orthodontics vary wildly. Here's how to decode your plan.
Dental insurance in Canada and the US is notoriously confusing. Unlike medical insurance, dental plans have annual maximums, waiting periods, and percentage-based coverage that varies by procedure category. Here's what most plans actually include.
The three tiers of coverage
- Preventive (100% covered by most plans): exams, cleanings, X-rays, fluoride treatments
- Basic restorative (typically 70–80%): fillings, simple extractions, root canals on front teeth
- Major restorative (typically 50%): crowns, bridges, root canals on back teeth, dentures, implants
Annual maximums
Most plans cap total annual benefits at $1,000–$2,000. Once you hit that cap, you pay 100% out of pocket for the rest of the year. Plan major work like crowns or implants strategically — ideally splitting procedures across two calendar years.
SmilesMatch lets you filter providers by which insurance plans they accept — so you never arrive at an appointment to discover you're out of network.
Orthodontics and cosmetic exclusions
Invisalign and traditional braces are covered under orthodontic riders — not standard dental plans. Many plans don't include ortho at all, or only cover it for patients under 18. Cosmetic procedures (whitening, veneers) are almost never covered.
Waiting periods
Most plans impose waiting periods of 6–12 months before covering major restorative work. If you need a crown soon after switching jobs or plans, you may have to pay out of pocket or delay the procedure.
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