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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What BC Employers Need to Know About Canada’s New Government Health Care Changes

At the Immix Group, every government announcement on healthcare changes sparks the same question from plan sponsors: “Will this shift claims away from our group benefits plan and reduce claim costs?”

 

by Lindsay Byrka, CFP® Vice President, Immix Group

Canada is known for universal healthcare, but each province and territory administers its own plan. While medically necessary hospital and physician services are covered nationwide, provinces decide eligibility and additional coverage. Coverage is based on residency and is portable within Canada. Funding comes from the federal government via the Canada Health Transfer.

For example, eye exam coverage for children varies: most provinces cover it, but a few leave the cost to private plans or individuals. So, while healthcare is universal, coverage differences exist, and some services remain the responsibility of private insurance or individuals.

Government coverage updates often attract media attention, and employers may assume this reduces the role of group benefits. Historically, shifts have gone both ways, but recent changes have increasingly shifted coverage back to the government.

Loosely, the Canada Health Act prohibits coverage or services for items already covered by public healthcare to avoid a two-tiered system. Group benefits plans and their offerings fall under ‘private insurance.’  Generally speaking, the plans are complementary – insurers do not need to cover and cannot cover these items.

This article walks through significant recent changes, provides an overview of these changes, their potential impact on employee benefits programs, and what employers need to know.

Canada Dental Care Plan (CDCP)

The Canadian Dental Care Plan (CDCP) launched the end of 2023. After some initial hiccups mostly centered around the hesitancy of dentists to sign up due to unclear terms and conditions surrounding claims reimbursement, these issues appear to have been worked out. Reportedly 98% of dentists now care for patients under the CDCP. With the latest expansion, nearly 5M Canadians now have approved applications. The program is adjudicated by SunLife Financial.

 

Does the Federal Canadian Dental Care Plan replace coverage through an employer-sponsored group benefits plan?

No. To qualify, you must have no access to any coverage including a private plan, employer’s plan or through a Health Spending Account. This program is designed for lower income individuals and families without access to coverage.

 

Could an employer terminate their dental coverage in order to shift this expense to the government?

The likely effect would be very few eligible employees, and coverage would be far less than under a typical group benefits program. The CDCP provides limited coverage, to a limited segment of people, based on family income:

  • 40% coverage for family income at $80-$90K
  • 60% coverage for family income at $70-$80K
  • 100% coverage for family income under $70K

As indicated, there is coinsurance, and additional fees may be required. Coverage is limited to certain items, most of which are basic services attached to preventative oral care. Higher cost items including crowns require preapproval and may or may not be covered. More costly items like dental implants are not included.

 

Employer Requirement to Report Dental Care Eligibility on T4s

Beginning for 2023, employers were required to indicate one of five codes in a new Box 45 on T4 Slips, indicating status as of December 31 of the tax year: 

    1. No access to any dental coverage
    2. Coverage for the employee only
    3. Coverage for employee, spouse, and dependents
    4. Coverage for employee and spouse only
    5. Coverage for employee and dependents only

This caused a lot of confusion initially, and at the Immix Group we answered many questions as to the notations, especially surrounding the timing. This is now a requirement each tax year.

 

What is the Impact of the Canada Dental Care Plan on Employee Benefits Programs? 

In short, the rollout of the Federal Dental Program has not had a notable impact on employer programs. Within our block of business, no changes were made to any plans due to the CDCP. The biggest impacts on dental costs to employers remain the same: higher costs charged by dentists (inflation, advances in technology etc), an aging population and workforce with higher needs, and greater adherence to a routine visitation schedule.

National Pharmacare Initiative: Continued Expansion

What is Bill C-64 and why should it matter to Employers?

We’ve received a lot of questions about the new Pharmacare plan, and whether this will mean a reduction in employer extended health care costs. Bill C-64 is a step towards a national universal pharmacare (i.e. drug coverage). In short, it authorized the federal government’s funding (via the provinces/ territories) to provide coverage for prescription contraceptives, hormone replacement therapy and diabetes medication and supplies.

The long-term goal is to achieve universal, single-payer coverage for a wider range of prescription medication. A national pharmacare program could help ensure that all Canadians have access to the medications they need, regardless of their income or where they live. The initial focus is on providing these medications free or at low cost, eliminating the need to coordinate with private insurance plans for these specific items. Several areas have recently been addressed which have received a lot of attention.

Prescription Birth Control and Hormone Replacement Therapy

 

Does government coverage for contraception and hormone replacement therapy medications replace employer-sponsored coverage?

As coverage is rolled out region by region, yes, it should mostly cover medications previously covered via employer group benefits plans.

Since April 2023 in BC, prescription birth control has been covered at the point of service, nearly eliminating the need for private reimbursement. There are a few medications that may not be covered, but generally, this was a broad change. Other provinces are now phasing in similar coverage as part of the pharmacare framework. Because BC already rolled out coverage for prescription contraceptives, the new funding will be directed towards hormone replacement therapy (HRT) in BC.

 

What is the Impact on Group Benefits Plans and Employers of Government Funded Prescription Birth Control:
Employers do not need to take action to remove specific drugs from their plans. As governments roll out these changes (as we already saw in BC), insurance carriers will adapt their coverage, ensuring private and group benefits programs no longer cover these items.

Financially, the effect may be minor—contraception and HRT tends to be lower-cost in the overall drug landscape, but this will differ depending on the demographics of your group.  

 

Family Planning and Fertility Benefits

While the Federal government has indicated the intent to expand coverage related to “fertility care, reproductive health, and family-building support” current coverage is via the provinces and territories and differs significantly.

As of July 2, 2025, for eligible applicants, BC funds one standard IVF cycle for ages 18-41. This new government coverage is income tested, looking to household income, and providing the maximum following benefits, for one IVF cycle and related medications:

  • Under $100K, $19K
  • $100K-$150K, $14,250
  • $150K-$200K, $9,500
  • $200K to $250K, $4,750

Over $250K of family income, no coverage is available via the BC government. It’s worth noting there are other common family-building/ fertility expenses beyond IVF such as egg / sperm freezing, IUI, and more, which remain outside the scope of government coverage.

 

What does the new BC IVF coverage this mean for employers and their group benefits plans?

At this point, not a lot. While it’s a small win for families who have struggled to conceive and the new government coverage in BC is a step in the right direction, this doesn’t mean much for employer cost shifting.  Most benefits programs offer very limited or no coverage at all for expenses related to fertility treatments. If some coverage is in place, it’s inadequate compared to actual costs for full circle fertility treatments such as In-Vitro Fertilization.

As the actual costs typically far exceed the combination of government and any available employer coverage, this is still an area where we feel most people will experience a large financial gap in coverage.

Diabetes Medications & Devices

The new Federal pharmacare initiative has also authorized coverage for eligible diabetes medication and supplies. This is being rolled out at different times, depending on the province or territory. Many provinces have signed agreements and some were in effect for mid 2025 (Manitoba, PEI). As of August 2025, some agreements are still pending, while Alberta has indicated they will opt out.  

For British Columbia, the expected timeline is:

  • Starting March 1, 2026: 100% public coverage for eligible diabetes medications (for both Type 1 and Type 2 diabetes)
  • Starting April 1, 2026: Expanded coverage for diabetes devices and supplies, including items such as glucose monitors and test strips.

Similar to what we already saw with prescription contraceptives, it’s expected costs will be covered at point of sale without copay or deductible.

 

Does the federal pharmacare agreement relating to diabetes treatments replace coverage through an employer-sponsored group benefits plan?

We expect to see a reduction in diabetes related expenses on employer plans. Diabetes medications represent roughly 15% of drug plan spending by dollars, largely driven by rising demand and the adoption of higher-cost therapies. With pharmacare coverage rolling out, employers may benefit from reduced claims for this therapeutic category.

Again, exact covered drugs and supplies will differ by province. While core medications like insulin and metformin will certainly be included, it is not yet clear whether newer, higher-cost therapies (such as GLP-1s like Ozempic and Trulicity) will be covered in full, and the extent or timing of coverage for supplies like insulin pumps, blood glucose monitors and test strips, per region.

 

Do Employers need to make changes to benefits plans due to the roll out of government coverage for diabetes treatments?  

As we saw with prescription birth control, insurance carriers will adjust eligible drugs under employer group benefits plans to coordinate with changes in provincial coverage, as these changes roll out. Employers and advisors will not need to take on the task of ensuring no duplication of coverage.

Service Canada Employment Insurance Extension for Sickness Benefits  

What change was made to Service Canada EI Sickness Benefits?

Service Canada expanded the benefit duration for EI Sickness benefits to 26 weeks effective for December 18th 2022. Previously, coverage was 15 weeks after a 2-week waiting period (17 weeks total).

 

Why does the change to EI Sickness Benefits duration have a potential impact on employer sponsored group benefits programs?

This is because of the alignment of benefit timing. Long Term Disability coverage is typically provided through group benefits programs, and LTD has traditionally aligned with the end of the old EI Sickness benefit duration, commencing after 119 days (i.e 17 weeks).

It is worth noting that insured STD is not very common with SMBs. Less than half offer this, and coverage is more common with larger employers. Most smaller companies rely on EI Sickness for this pre-LTD period.

 

Do Employers need to adjust Long Term Disability plan waiting periods due to the change to EI Sickness Benefits?

Shifting to a longer waiting period has not made sense in most instances. Under a properly set up LTD plan, LTD should pay a great percentage of income replacement and an overall higher amount of benefit per month than under EI Sickness, which is limited to 55% of weekly earnings, to a max of $695 taxable (2025). LTD is usually 67% of pre-tax earnings, to a maximum, most commonly received tax free due to employee-paid premiums.

The premium reduction offered by insurance carriers to extend the group LTD waiting period from the usual 119 days to 182 days is very minor (2-3%), meaning it was overall more beneficial to have disabled plan members move more quickly to Long Term Disability.

At the Immix Group, across our block of business, we did not see employers make the switch to a longer group Long Term Disability elimination period. While we have established new group benefit plans since this time with 6-month LTD waiting periods, and these groups are usually smaller and with average incomes on the lower end.

 

Awareness and Communication is Key

Recent government health care changes are a positive step toward expanding access, and employers may see some costs shift away from their plans, potentially reducing claim expenses. Coverage varies by province and income level, so employers should stay aware of changes in their region. Generally, employers don’t need to amend their benefit plans; the key is staying informed—understanding how new programs work, how eligibility is determined, and how these changes interact with group benefits. Staying up to date helps employers maintain strong, competitive programs.

 

 

Key Takeaways

Employee benefit plans still essential – Government programs add safety nets but don’t replace group benefits. Expansions to government coverage will reduce some costs for some employers.

Dental plan impact minimal – CDCP is only for those without private coverage or access to coverage; employers must now report dental access on T4s.

Expanded Pharmacare rollout – Contraceptives, HRT, and diabetes drugs/devices are shifting to public coverage region by region; insurers will adjust automatically.

IVF coverage in BC – While federal coverage is still in the works, BC now funds one income-tested IVF cycle. However, due to the high costs and since most benefits plans offer little or no fertility coverage, the result is expected to be a minimal impact on employer plans.

EI sickness extension – Benefits extended to 26 weeks, but most employers haven’t changed LTD plans since LTD remains stronger.

Awareness is key – No major plan changes needed; employers should focus on communicating what new coverage means for employees.

FAQ’s

Does the Canadian Dental Care Plan replace employer dental coverage?
No. It only covers those without private or employer-sponsored dental coverage, and provides limited benefits based on income.

Do employers need to change their benefit plans because of expanded national Pharmacare coverage?
No. Insurers will automatically adjust plans as coverage rolls out for contraceptives, HRT, and diabetes medications/devices.

What does BC’s new IVF coverage mean for employers?
BC now funds one IVF cycle, with income-tested eligibility. However, costs usually exceed government support or traditional coverage under benefits plans, so there is minimal impact on employer plans.

Can employers expect cost savings from these government changes?
Potentially. Some costs may shift from employer plans to government programs, which could reduce claim expenses.

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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