Private Health and Dental Insurance for Self-Employed and Early Retirees
This spoke is under the Canadian insurance planning guide. Costs that show up after you stop working, beyond the dental plan, are healthcare costs in retirement. A facility years later is long-term care costs. Care outside Canada is travel medical insurance, which a domestic health plan does not replace.
- As of the qualify page reviewed in September 2026, CDCP eligibility needs adjusted family net income under $90,000, a filed return, Canadian tax residency, and no private dental access.
- Private access includes an employer or a family member's employer, a pension plan, a professional or student organization, and insurance you or a family member bought. Health and wellness accounts are included.
- A retiree exception exists if you opted out of pension dental before December 11, 2023, and the pension rules will not let you opt back in.
- Canada.ca's coverage page, as used on the dental plan eligibility guide, sets co-payments at 0 percent under $70,000, 40 percent from $70,000 to $79,999, and 60 percent from $80,000 to $89,999 of the plan's own fees.
- Premiums you pay to a private health services plan can be medical expenses if 90 percent or more of the premium is for eligible expenses. Provincial plans such as OHIP are not eligible medical expenses.
Who pays for which bill?
| Layer | What it is for | What it does not do |
|---|---|---|
| Provincial or territorial health insurance | Medically necessary physician and hospital care in the province, on that province's terms. | Routine dental, most vision care, and many drugs. Out-of-country care is not a plan you can build a trip on. See travel medical. |
| Canadian Dental Care Plan | Dental for residents under the income test who have no private dental access. | Drugs, disability income, or a hospital outside Canada. A private dental plan, even a poor one, can make you ineligible. |
| Private health and dental | Drugs, dental, vision, and paramedical care the province leaves to you, inside annual maximums and fee guides the contract states. | Replace disability insurance or critical illness. A dental maximum is not an income plan. Those contracts are the disability guide and critical illness. |
| Quebec prescription drug insurance | Mandatory drug coverage. RAMQ says everyone permanently settled in Quebec must be covered, by the public plan or a private plan. If you are eligible for a private plan and under 65, you must join it. | A substitute for dental. RAMQ says the public drug plan covers around 8,000 prescription drugs. Dental is a different benefit. |
Table as of September 2026. CDCP rules are from the qualify page. Quebec rules are from RAMQ. Private-plan maximums are in your certificate, not here.
When does a private dental plan hurt more than it helps?
The qualify page is blunt. You do not qualify for the CDCP if you have access to dental coverage through your employer, a family member's employer, a pension, a professional or student organization, or a policy bought from an insurer, including through a group plan. That remains true if you decide not to take the coverage, if you must pay a premium, or if you do not use it. The adjusted-family-net-income test uses line 23600 of each spouse's return, minus universal child care benefit and RDSP income, plus amounts of those benefits repaid. Under $90,000 is the line on the page reviewed in September 2026.
Canada.ca's coverage page sets the co-payment on the plan's own fees: none under $70,000 of adjusted family net income, 40 percent from $70,000 to $79,999, and 60 percent from $80,000 to $89,999. A clinic can still charge more than the plan fee. Application steps and the worked examples are the Canadian Dental Care Plan eligibility guide. The qualify-page tests on this page are the reason a private dental plan can close that door.
A couple in British Columbia retires at 60. Workplace benefits end the month the job ends, which is the group versus personal problem. Their adjusted family net income is $68,000 in this illustration, under the $90,000 CDCP line, and they have no pension dental plan. They qualify to apply if they also meet residency and filing rules. A broker offers a private dental plan with a low annual maximum. Joining it is "access to private dental insurance" on the qualify page, even if the maximum is small and they never claim. In this illustration the private plan can cost them CDCP eligibility. The right comparison is the private plan's premium and maximum against CDCP coverage they would lose, not against an uninsured toothache. If income later rises to $90,000 or more, the public plan's income test fails and the private market is the remaining dental option. Income in the illustration is not a quote of their taxes. Run line 23600.
Can you deduct the premium?
CRA's medical-expense guide, RC4065, says premiums paid to private health services plans, including medical, dental, and hospitalization plans, can be claimed as medical expenses when 90 percent or more of the premiums are for expenses that qualify for the credit. Amounts reimbursed by the plan are not also claimed. Premiums for provincial and territorial plans, and the list includes the Alberta Health Care Insurance Plan and OHIP, are not eligible. Employer-paid premiums that were not included in your income are not your claim. The credit has an income threshold on the return. This page does not restate that dollar floor. Use the worksheet for the year you file. The missed tax credits guide is the habit of actually claiming the lines you qualify for.
Drug and dental maximums pay bills. They do not replace a consulting draw. Self-employed readers still need the disability page. A critical-illness lump sum is a third contract. Stacking all three without a job for each one is how people over-insure, which the shopping guide is written to stop.
Frequently asked questions
Does OHIP or my provincial plan cover dental?
Routine dental is outside ordinary provincial physician coverage. Some provinces fund limited dental programs for children, seniors, or people on social assistance. Those programs have their own rules. The Canadian Dental Care Plan is the federal plan with the under-$90,000 income test and the no-private-coverage test. Read both before you assume a cleaning is insured.
If I waive dental at work, can I get the Canadian Dental Care Plan?
The qualify page says no. Access through your employer or a family member's employer counts even if you refuse the plan, pay a premium for it, or do not use it. Health spending accounts are included in that access. Waiving coverage to qualify is the mistake the page is written to prevent. The exception it does describe is a narrow pension opt-out made before December 11, 2023, where you cannot opt back in.
What are the CDCP co-payments?
Canada.ca's coverage page sets no co-payment under $70,000 of adjusted family net income, 40 percent from $70,000 to $79,999, and 60 percent from $80,000 to $89,999, applied to the plan's fees. You can still owe the dentist any amount above that fee. The tiers, the 2026–27 benefit year, and a worked example are the eligibility guide.
I am self-employed and have no benefits. What should I buy?
Check the CDCP test before you buy dental. If you are over the income line or you want drugs and paramedical coverage the province does not provide, price a private plan on its annual maximums, waiting periods, and pre-existing condition rules, not on the brochure's category list. In Quebec, drug coverage is mandatory: join a private plan if you are eligible, or register with RAMQ if you are not. Disability insurance is still a separate purchase.
Are retiree health premiums a medical expense?
Premiums you pay yourself to a private health services plan can qualify when at least 90 percent of the premium relates to eligible medical expenses. CRA's guide says so, and it excludes provincial health premiums. Keep the invoice. If the former employer pays and the amount is not in your income, you do not claim it again. Reimbursed expenses are not claimed either.
Does private health insurance cover me outside Canada?
A domestic extended-health plan sometimes includes a short emergency-travel benefit, with a day limit and a dollar cap in the certificate. It is not a substitute for reading that cap before a long trip. Snowbird coverage is the travel-medical guide. Provincial out-of-country amounts are small relative to a US hospital. This page does not quote them, because ministries change them.
Sources
- Canada.ca: Do you qualify for the Canadian Dental Care Plan
- Canada.ca: Canadian Dental Care Plan coverage and co-payments
- Health Canada, December 2023: CDCP announcement
- CRA RC4065: medical expenses, including private health premiums
- RAMQ: obligation to have prescription drug insurance
- RAMQ: public drug plan eligibility, including the figure of around 8,000 drugs
Dental eligibility is a tax-return test.
Line 23600 and the medical expense claim live on the return. The 2026 tax guide is that worksheet.
Get the 2026 Tax Guide — $49 CAD
