Dental Benefits

Immix Insights • April 2026

Why Dental Benefits Keep Getting More Expensive and What Employers Should Know

Dental coverage remains one of the most valued parts of an employee benefits plan, but it is also one of the areas where employers continue to see cost increases.

Dental coverage remains one of the most valued parts of an employee benefits plan, but it is also one of the areas where employers continue to see cost increases.

Plan sponsors are asking many of the same questions. Why are dental claims rising? How much of the increase comes from new dental fee guides? Is the Canadian Dental Care Plan changing anything for employer-sponsored group plans? And what can employers do to keep coverage sustainable without simply shifting more cost onto employees?

The reality is that dental inflation is being driven by more than one factor. Fee guide increases do matter, but they are only part of the story. Higher utilization, rising practice costs, and more complex treatment patterns are also contributing to growing dental spend.

There is also confusion around the Canadian Dental Care Plan. While it is an important public program, it does not replace employer-sponsored dental coverage and it does not make private plans cheaper for employers.

For employers, the real question is not whether dental costs are rising. It is what is driving those increases, how they affect renewals and long-term plan sustainability, and what options exist to manage them well.

In this article, we look at the 2026 dental fee guides, the other forces driving dental costs upward, why the CDCP does not change the economics of employer plans, and where options like Health Spending Accounts and supplemental coverage come into play.

Why dental costs are rising

Dental costs are rising in 2026 for a few reasons at once.

The first is simple. The cost of delivering dental care continues to increase. Like many health services, dental practices are dealing with higher staffing, supply, equipment, and operating costs. Over time, those pressures show up in treatment costs and, in turn, in dental claims.

The second is utilization. People with dental coverage are more likely to use it, especially for routine and preventive care. That is not a bad thing. In many cases, it means employees are getting the care they need. But it also means total plan spending can rise even when the plan itself has not changed.

Treatment complexity also plays a role. As workforces age and more people stay engaged with regular care, plans may start to see more restorative and major dental work over time, not just cleanings and basic exams. On top of that, advances in technology mean more expensive equipment used in the dental offices.

For employers, that is what makes dental spending harder to predict. Costs can rise even without a major plan design change, because the pressure is coming from several directions at once.

The annual dental fee guide is part of that story, but it is not the whole story. It helps explain why claims move upward, but so do broader inflation, higher utilization, and the growing cost of care. That is why it helps to think about dental inflation as a trend driven by both price and usage, not just by one change in the market.

What the dental fee guide means for dental expenses

The dental fee guide is one of the clearest reasons dental claims rise over time, but it is often misunderstood.

Each province publishes a suggested guide that sets benchmark fees for dental procedures. In Canada, dentists are not required to charge those exact amounts, but the guide still matters because most dental offices adhere to this guide, and most benefit plans use it as the basis for reimbursement.

That means when the fee guide goes up, claim costs often go up with it. Even small increases in common services can add up across a workforce over the course of a year. Consider an exam at $200 in 2021:

BC dental fee guide example from 2021 to 2026
Year BC Fee Guide Increase Dental Cost ($)
2021 Base 200
2022 7.35% 214.7
2023 5.99% 227.56
2024 4.73% 238.34
2025 3.27% 246.14
2026 2.66% 252.69

Factoring in only the fee guide, that same $200 would cost $253 just 5 years later.

The fee guide is not the only reason dental costs rise, but it is one of the easiest places to see how annual inflation begins to move through a benefits plan and eventually affect renewal discussions. This is the basis for a common frustration for employers; seeing dental claims rise when the coverage (i.e. 80%) and annual plan limits (i.e. $2,000) have stayed the same.

Why claims rise even when plan design does not change

One of the most common frustrations for employers is seeing dental claims increase even though the plan design itself has not changed. Coverage levels are the same. Annual maximums are unchanged. Reimbursement percentages look identical year over year. Yet total claims still rise.

The reason is that plan cost is driven by behaviour and usage, not just plan rules.

Dental plans are sensitive to who is actively using the coverage and what type of care they are accessing. Even small shifts in utilization patterns can materially affect total claims across a group.

For example, as employees settle into a workplace and become more comfortable using their benefits, routine care tends to become more consistent. Missed cleanings are caught up on. Long deferred treatment gets addressed. Employees who may not have had coverage before begin to use it regularly. None of this requires a plan change, but it does increase claim volume.

Over time, treatment mix also changes. A workforce that maintains regular preventive care will eventually generate more restorative and major claims. Fillings follow cleanings. Crowns follow fillings. Periodontal treatment becomes more common as employees age. These services cost more than basic exams, even when reimbursement percentages remain the same.

Turnover can amplify this effect. New hires often arrive with unmet dental needs and immediately use coverage. Departing employees may complete major work before giving notice. As the group changes, the pattern of claims changes with it.

The result is that claims pressure can build quietly, driven by utilization and treatment mix rather than plan generosity. From the employer’s perspective, it can feel disconnected from any conscious decision about benefits. The plan looks the same, but the experience inside it has evolved.

This is why dental renewals can increase even in years when nothing appears to have changed. The structure of the plan is stable, but the cost and timing of care within the plan are not.

Canadian Dental Care Plan Mean for Employers—and What Doesn’t It Change?

The Canadian Dental Care Plan has received a great deal of attention, but it does not change the basic economics of employer-sponsored dental coverage.

The CDCP is a public dental program for eligible Canadians who do not have access to private dental coverage. That is an important point, because it means it is not designed to replace employer plans or reduce costs for employers already offering dental benefits.

For plan sponsors, this is where some confusion has crept in. The existence of a public dental program can make it sound like pressure on private plans should ease. In practice, that is not how the program works. Employees who have access to employer-sponsored dental coverage generally are not the people the CDCP is meant to serve.

Employer plans still play a different role in attracting talent, supporting employees, and providing predictable access to care. The CDCP matters in the broader conversation about access to dental care in Canada, but it does not reduce renewal pressure on private plans or make employer dental coverage less relevant.

For employers considering dropping or not implementing dental coverage, it’s worth noting that eligibility for the CDCP is income-tested, restricting access to those under defined income thresholds. Although it improves access to care for low income people, the program’s fee schedule and coverage levels are limited, often falling short of typical dental costs.

What this means for employers

For employers, rising dental costs are not just another line item, they are a signal about the long-term sustainability of the plan.

When claims continue to increase, the impact shows up at renewal. Underwriters typically look ahead, not just back, applying assumptions that anticipate continued growth in claims. The result is often higher costs, more difficult decisions, and increased scrutiny of whether the current plan is still working as intended.

This is where many employers get stuck. They want to provide meaningful coverage and avoid scaling back benefits unnecessarily. At the same time, a pattern of rising claims year after year is difficult to ignore or absorb.

Part of the challenge is that dental pressure is easy to misinterpret. Higher claims do not necessarily mean the plan is too generous. In many cases, they reflect broader factors such as increased cost of care, more consistent utilization, or a shift toward more complex treatment. Often, it is a combination of all three.

That is why employers need more than a renewal number—they need context. An in-depth review should identify what is actually driving the increase, where the pressure is coming from, and whether the plan remains aligned with the needs of the workforce. The goal is not simply to react to rising costs, but to understand them well enough to make informed, sustainable decisions.

How should employers approach rising dental plan costs?

The first step is to review the plan with a clear understanding of what is driving the increase.

That means looking beyond the renewal number. Employers should understand which services are driving claims, whether the plan is tied to the current fee guide or a lagged year, and where cost pressure is building over time. From there, it may make sense to adjust how the plan is structured. In some cases, the answer is not richer coverage. It is better balance.

That could mean reviewing reimbursement levels, annual maximums, coverage for major services, or how often certain services are covered. The right approach depends on the workforce, the budget, and the role benefits play in recruitment and retention.

Health Spending Accounts can also help. They give employers a way to add flexibility without relying only on a traditional insured plan. In the right situation, an HSA can help cover eligible dental expenses while giving employers more control over how dollars are allocated.

Communication matters too. Employees do not always understand how their dental coverage works, what is covered, or where out-of-pocket costs may still apply. Clear communication can help reduce confusion and make the plan feel more valuable.

The goal is not simply to cut costs. It is to build a dental strategy that stays useful, sustainable, and realistic over time.

What individuals can do if dental coverage is limited

When dental coverage is limited, the best next step is usually to look at where the gap actually is.

For some people, the issue is no coverage at all. For others, it is coverage that helps with basic care but leaves larger out-of-pocket costs for more expensive treatment.

In those situations, there may be other options to consider. Health Spending Accounts can help in some cases, especially when flexibility matters more than a traditional one-size-fits-all plan. Individual health and dental plans may also be worth exploring for people who do not have access to employer coverage, or recently lost group coverage. For high dental costs that end up paid out of pocket, in Canada eligible dental expenses can be claimed as part of the Medical Expense Tax Credit (METC) on your personal tax return

The important point is that limited coverage does not always mean there are no options. It usually means taking a closer look at what kind of support makes the most sense for the person, the family, or the business.

How employers can move forward with clarity

Rising dental costs are not the result of a single change, but a combination of factors that build over time—fee guide increases, higher utilization, and the growing cost and complexity of care. For employers, the challenge is not just managing renewal increases, but understanding what is driving them and how the plan should evolve in response. Reviewing recent claims experience, separating price effects (such as fee guide movement) from utilization and treatment mix, and stress-testing plan design choices can help employers make decisions that support both affordability and access to care.

Key takeaways

  • Dental costs rise due to a combination of fee guide increases, higher utilization, and more complex care.
  • Claims can increase even when plan design stays the same, because usage patterns and treatment costs continue to evolve.
  • The CDCP improves access for eligible Canadians but does not replace employer-sponsored coverage or reduce cost pressure on private plans.
  • For employers, the priority is understanding what is driving costs and ensuring the plan remains aligned with workforce needs.
  • For individuals with limited coverage, options such as HSAs or individual plans may help bridge the gap.

FAQ

Does the CDCP replace employer dental coverage?

No. The CDCP is for eligible Canadians who do not have access to private dental coverage, including employer-sponsored plans. It is not a replacement for employer dental benefits, and it does not reduce cost pressure on private plans.

Why can dental claims rise if the plan has not changed?

Because plan cost is influenced by more than plan design. If the cost of care goes up, if employees use their coverage more consistently, or if more claims involve higher-cost treatment, total spending can rise even when the plan structure stays the same.

Does the fee guide control what every dentist charges?

No. The fee guide is a benchmark, not a mandatory price list. Even so, it still matters because many dental reimbursements are tied to it.

Can an HSA help with dental costs?

In some cases, yes. A Health Spending Account can help employers add flexibility by reimbursing eligible medical and dental expenses on a tax-effective basis. That can make it a useful supplement to a traditional benefits plan.

What if someone does not have enough dental coverage?

That depends on the gap. Some people may want to look at an individual health and dental plan, while others may want to supplement existing coverage with another solution. The right answer depends on the person, the family, or the business.

Further Reading

Health Spending Accounts (HSAs)

A primer on how HSAs can reimburse eligible medical and dental expenses, how they are commonly coordinated with insured benefits, and where they may add flexibility.

Next steps: reviewing dental plan sustainability for 2026

If dental claims are increasing, it can help to step back and confirm which factors are driving the change (for example: fee guide movement, utilization, treatment mix, and the cost of care).

A structured review typically looks at plan design (coverage levels, frequency limits, annual maximums, and major services), cost-sharing (deductibles and coinsurance), and supporting strategies such as HSAs or supplemental arrangements. The objective is to keep coverage meaningful for employees while managing long-term affordability for the organization.

For more information or to request a plan review: https://www.immixgroup.ca/contact.php

Howard

Howard Cheung BBA

Employee Benefits Consultant, Immix Group: An Employee Benefits Company A Suite 450 – 888 Dunsmuir St. Vancouver V6C 3K4

Ph 604-688-5559

E info@immixgroup.ca

W www.immixgroup.ca

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Your Benefits, Your Way: The “101” on Health & Wellness Spending Accounts

If you’re a Canadian business owner looking to offer flexible, tax-effective coverage that empowers your team, an HSA could be the missing piece of your benefits offering.

In this guide, we’ll break down what an HSA is, how it works, and why businesses like yours are making it a staple in their employee benefits package.

Health and Wellness Spending Accounts are Increasing in Popularity

Most people have heard of Health Spending Accounts, which have become increasingly popular over the past decade or so, with around 40% of plans offering some form of HSA.

This is in response to multiple generations in the Canadian workforce and their diverse needs, the increasing desire for flexibility and choice, and the simplicity of offering this predictable-cost benefit.

Most Canadian carriers now facilitate not only Health Spending Accounts (non-taxable, for items on the CRA’s Eligible Medical Expense listing) but also Wellness or Lifestyle Spending Accounts (taxable items that fall outside the CRA listing). In addition, many specialty providers offer robust, low-cost, user-friendly platforms for Health and Wellness Spending Accounts with many customizations available.

What is a Health Spending Account? 

A Health Spending Account is set up by an Employer and provides a pre-determined annual allocation to an Employee, to be used for CRA-eligible medical expenses. Employees have the flexibility to choose which expenses are submitted through the Health Spending Account. Employees receive reimbursement for eligible claims on a tax-free basis. As the Employee uses their account, their available balance reduces.

Employers pay for the amount of the expense, plus an administrative charge for adjudication, and any applicable taxes on the admin fee. The total expense is tax-deductible to the Employer. To be CRA-compliant, Health Spending Accounts need to be facilitated via a third-party provider.

What is a Wellness Spending Account (WSA)?

Also known as a Lifestyle Spending Account (LSA), the primary difference from a Health Spending Account is WSAs/ LSAs are for taxable expenses (i.e. those not found under the CRA listing). The funding and cost for the Employers are the same as with a HSA, and Employers can also deduct the expense. The main difference is that expenses reimbursed through a Wellness/ Lifestyle Spending Account are a taxable benefit to Employees.

What is a Flexible Spending Account?

This simply refers to an account where the employee has both HSA and WSA reimbursement available. Typically, they can choose what percentage of the total allocation falls into each of the buckets (taxable or non-taxable) as described.

health spending account vs. wellness spending account Canada chart by Immix Group

Collectively, many people refer to these accounts as “Health Spending Accounts” or “Health Care Spending Accounts” or by the American term “Health Savings Accounts,” although they may offer the ability to remit expenses under each tax bucket.

The Benefits: Why More Employers are Implementing Health Spending Accounts

From our perspective as benefits advisors, the answer to this is twofold: employees love Health Spending Accounts for the flexibility and choice, and employers find them cost-effective, simple and practical. The benefits are vast:

  • Provides employees with choice and flexibility as to how benefit dollars are spent.
  • Supplements insured benefits program reimbursement for example topping up an insured benefit item where a dollar limit has been reached.
  • Cost control for employers; there is an upper limit per year and a defined admin fee, so no surprises!
  • Ability to highly customize including with classes of coverage with varying levels of allocation.
  • High value to invest in wellness programs, with research indicating 300-400% ROI.
  • Tax advantaged as a fully deductible expense for employers.

What sorts of items can be covered through a Health Spending Account?

HSAs can cover a wide range of expenses as determined by the CRA Eligible Medical Expense Listing similar to traditional health benefits, including:

  • Dental treatments and orthodontics
  • Prescription drugs and medical devices
  • Paramedical services like massage therapy, physiotherapy, and acupuncture
  • Vision care, including glasses and laser eye surgery
  • Medical equipment, supplies or surgeries
  • Mental health practitioners
  • Insurance premiums, deductibles and coinsurance from insured plans

Wellness Spending Accounts can cover nearly anything the employer desires! Common expenses include:

  • Gym memberships, fitness classes
  • Activity passes such as ski passes
  • Children’s sports
  • Childcare expenses
  • Vitamins and supplements
  • Fitness equipment
  • Contributions to RRSPs
  • Medical practitioners excluded by the CRA such as alternative health practitioners

Health Spending Accounts vs. Traditional Insured Benefits

At the Immix Group, we firmly believe that Health & Wellness Spending Accounts should be considered as a supplement to a more robust insurance program that offers coverage for prescription drugs, emergency out-of-country travel, dental, and other more catastrophic insurance coverage such as life, critical illness and disability.

With the defined dollar limit provided via a Health Spending Account, it works best as a supplement to provide flexibility and choice to a base insurance plan. In short:

Traditional Insured Plans:

  • Pre-defined coverage with limits on certain services but typically covers catastrophic expenses at first dollar.
  • Best for drugs, travel, disability, and items where true “insurance” is needed to guard against the unknown.

Health & Wellness Spending Accounts:

  • Top-up insured programs where limits are in place, or cover un-insured items.
  • Flexible spending based on individual needs.
  • Allow reimbursement for wellness and lifestyle expenses not included through traditional insured benefits programs.

Key Features: With a Health Spending Account you can:

  • Implement classes with different allocations available for different employee classifications.
  • Allow one-year carry forward of unused balances (one year only, per CRA).
  • Implement coinsurance (i.e. 50% reimbursement up to a total limit).
  • Define the items covered within a Wellness Spending Account.
  • Implement dedicated accounts to target specific areas (i.e. PPE account, Mental Health account, Childcare account).
  • Easily pull reporting for tax purposes.
  • Make changes to the allocation you provide at the start of each year.

A Predictable, Low-Cost Benefit for Employers

One of the main reasons employers are drawn to Health Spending Accounts is the cost predictability and transparency.  

  • Low administration cost, usually ranging from 3-10% on submitted expenses (plus applicable taxes on the admin charge only).
  • Ability to change the offering each year, to adjust to budget constraints.
  • Ability to implement ‘use it or lose’ rather than the ability to carry forward unused balances in order to have even greater cost predictability in a given period.

On average, employees typically spend around 60-70% of their allocated amount, making this a good estimate for employers looking to budget. Ultimately, the ‘worst case scenario’ (or best case scenario, depending on how you think about it!) is that all employees use 100% of their allocation.

A Hidden Perk: The Tax Advantage

Health & Wellness Spending Accounts aren’t just flexible — they’re smart.

  • For Employers: Contributions are 100% tax-deductible
  • For Employees: Reimbursements are tax-free for Health Spending Accounts

Although Wellness Spending Account reimbursements are a taxable benefit, most employees still see this as a huge perk as the cost of paying the tax on an expense is of course a small amount relative to paying out-of-pocket for the same item. For employers, providing funds via an HSA is less costly than the equivalent in salary.

HSA vs WSA

What kind of Employer should implement a Health Spending Account?

The short answer? Every size of business, even a one-person incorporated company. While we do believe in providing a base insurance program to ensure proper protection against major expenses, there is a place for a Health Spending Account whether you are a two-person tech start-up in Vancouver British Columbia or a larger, established employer in Ontario.

Implementing a Health Spending Account can be a game-changer for:

  • Small businesses that want flexible coverage and don’t yet have the budget for a traditional insured plan.
  • Growing teams looking to offer competitive benefits.
  • Companies with diverse needs where one-size-fits-all plans don’t cut it.
  • Companies that want to customize their offering through targeted Health Spending Accounts.

 

How to Set Up a Health and Wellness Spending Account

First, you can set up a Health Spending Account with either a dedicated specialty provider (such as myHSA) or as an add-on to your program with your insured benefits provider.  

An advantage of implementing a program with your insurance provider (for example Manulife, Sunlife, Pacific Blue Cross) is the ability to more seamlessly direct unpaid claim balances towards the Health Spending Account. However, insurance providers tend to be more costly and less flexible with account parameters.

Our preference is to work with a dedicated HSA provider.

HSA 9

Getting started is easier than you might think.

At the Immix Group, we help businesses build benefits plans that are clear, custom, and transparent — and that includes HSAs.

We help you to:

  • Set a Budget: Choose how much you’ll contribute per employee on an annual basis.
  • Establish Rules: Decide what expenses are eligible, and features such as whether to include the ability to carry forward unused balances, whether to allow employees to include expenses for dependents etc.
  • Communicate Clearly: Educate your team on how to use their HSA effectively, in conjunction with any other benefits programs in place.
  • Adjust as Need: Employees will submit expenses and be reimbursed, thereby reducing their available balance. The plan sponsor will have the ability to review the overall usage and make any changes to allocations or customizations, as needed (typically after the plan has been in place for one year).

 

Is an HSA Right for Your Business? Let’s Chat!

If you’re ready to explore how a Health & Wellness Spending Account can help you control costs while giving your team greater flexibility, we’re here to guide you. Reach out to us at info@immixgroup.ca or (604) 688-5559  – we love to hear from you!

Top 10 FAQs

An HSA is an employer-funded account that allows employees to be reimbursed for CRA-eligible medical expenses on a tax-free basis.

Employers allocate a set amount per year to employees, who then use it to cover eligible health expenses. Employers only pay for actual claims submitted, plus administrative fees.

A WSA (or LSA) covers taxable expenses such as gym memberships and wellness programs. Unlike an HSA, reimbursements are considered taxable income for employees.

While possible, HSAs are best used as a supplement to traditional benefits to provide more flexibility and customization.

Minimum amounts typically start at $250 per employee, with executive-level accounts often reaching tens of thousands per year.

Yes, all employer contributions to an HSA are 100% tax-deductible, making them a cost-effective way to provide benefits.

Employers can allow a one-year carry forward of unused balances, but beyond that, the funds expire as per CRA rules.

Any incorporated business can set up an HSA, including small businesses, self-employed individuals, and large companies. An HSA can be set up for just one person, but the business must be incorporated, and the individual must receive T4 income. Shareholders typically cannot participate.

Eligible expenses include dental treatments, prescription drugs, paramedical services, vision care, and medical equipment, among others.

Employers can set up an HSA through an insured benefits provider or a specialty provider, customizing rules and contribution levels as needed.

This restriction is due to compliance with CRA regulations, which require allocations to be determined in advance.

Key Takeaways

  1. HSAs Offer Flexibility & Choice
    Employees can use HSAs for a wide range of medical expenses based on their individual needs, making them more adaptable than traditional one-size-fits-all benefits plans.
  2. Cost Control & Predictability for Employers
    Employers can set defined contribution limits, ensuring there are no surprise costs. The ability to adjust annual allocations or enforce a “use-it-or-lose-it” policy adds further financial control.
  3. HSAs Are a Tax-Effective Way to Provide Benefits
    Contributions are fully tax-deductible for employers, and reimbursements are tax-free for employees—making HSAs a more cost-efficient alternative to salary increases.
  4. WSAs Can Boost Employee Engagement & Wellness
    By covering wellness-related expenses like fitness memberships, mental health services, and even childcare, WSAs help promote employee well-being and work-life balance.
  5. Combining HSAs & WSAs Maximizes Employee Satisfaction
    Offering both allows employees to balance healthcare needs with lifestyle benefits, increasing overall satisfaction and retention. Employers can customize coverage to align with company culture.
  6. Ideal for Small Businesses & Large Enterprises Alike
    HSAs and WSAs are scalable solutions, benefiting businesses of all sizes—from startups looking for an alternative to traditional insurance to large corporations adding customization to their benefits package.
  7. Implementation is Simple with the Right Provider
    Employers can integrate an HSA/WSA into their benefits program seamlessly through an insurer or third-party provider, with many offering user-friendly digital platforms for easy claims processing. Using a third party ensures compliance with tax regulations, simplifies administration, and helps maintain proper documentation for CRA purposes.
Lindsay Byrka

Lindsay Byrka, CFP® BA, BEd

Vice President, Immix Group: An Employee Benefits Company
A Suite 450 – 888 Dunsmuir St. Vancouver V6C 3K4
O  604-688-5262 

E lindsay@immixgroup.ca
W www.immixgroup.ca

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