Does insurance cover braces or Invisalign in British Columbia?

MSP

The BC Medical Services Plan does not cover orthodontic treatment, except in limited hospital programs for conditions such as cleft lip and palate and some jaw surgery cases. For nearly everyone, orthodontics is paid privately or through extended health insurance.

Employer and private plans

Many extended health plans include orthodontic coverage, and a typical structure is:

• Percentage: the plan pays 50 percent of the fee (sometimes 60 or higher, occasionally lower).
• Lifetime maximum: up to a fixed amount per person, commonly $1,500 to $3,000, occasionally more. Once used, it does not renew.
• Eligibility: some plans cover dependent children only, to age 19 or 21; some cover adults.
• Waiting period: some plans require a period of coverage before orthodontic benefits begin.
• Payment pattern: some insurers pay in instalments over treatment rather than a lump sum.

The lifetime maximum is the number that determines your cost. Fifty percent of a $6,000 fee is $3,000, but a $2,000 lifetime maximum means the plan pays $2,000.

Two plans

If both parents have coverage, the child's primary plan is usually the plan of the parent whose birthday falls earlier in the calendar year. The secondary plan can pay part of what the primary does not, up to its own maximum. The clinic's coordinator handles this.

Direct billing

myORTHODONTIST Maple Ridge bills insurers directly, so you pay the difference rather than the full fee up front. A pre-determination is submitted before treatment so you know your coverage in writing.

Questions to ask your insurer

1. Does my plan include orthodontic coverage, and for whom?
2. What is the percentage and the lifetime maximum per person?
3. Is there a waiting period or an age limit?
4. Does the plan pay a lump sum or instalments?
5. Is a pre-determination required?

Other help

Health spending accounts apply. Orthodontic fees are an eligible medical expense on your tax return. Interest-free monthly plans through the clinic cover the balance. See monthly payment plans and cost and insurance.