RAMQ dental coverage is Quebec’s public dental insurance program managed by the Régie de l’assurance maladie du Québec. Unlike Quebec’s universal medical coverage, this dental coverage is quite restrictive and limited to specific categories.
Many Quebec residents mistakenly believe that their provincial health insurance covers dental care the same way it covers doctor visits, but it does not. RAMQ dental coverage operates based on specific criteria related to age and income support status.
Learn more details about who qualifies for coverage, what services are included at each stage, and how Quebec’s dental provincial coverage interacts with the government benefits in this article.
Who is Eligible for RAMQ Dental Coverage?
Only two groups qualify for this Régie de l’assurance maladie dental coverage:
- Children under the age of 10.
- Recipients of financial assistance programs who have a valid claim slip (carnet de réclamation). Separately, all insured persons requiring specific oral surgery services are to be performed in hospitals.
As a result, the vast majority of adults in Quebec, including seniors, working families, and middle-income earners, do not have any RAMQ dental coverage. If you do not belong to one of these three categories, you will need to pay for dental services out of pocket or rely on private insurance.
To verify your eligibility and coverage details, contact RAMQ directly by phone at 1-800-561-9749, visit a RAMQ service point in person, or use the RAMQ online services portal.
What does RAMQ Dental Coverage Cover?
For all Quebec residents with a valid Health Insurance Card, the RAMQ covers specific oral surgery services only when these procedures are performed in a hospital setting. The medically necessary procedures that are covered include:
- Surgical removal of cysts or tumours
- Drainage of abscesses and treatment of bone infections (osteitis)
- Repair of soft tissue lacerations (in areas such as the tongue, cheek, or palate)
- Reduction of jaw or alveolar fractures
- Jaw repositioning and treatments for salivary gland issues or temporomandibular joint disorders
However, because your category dictates coverage, first identify your category: child under 10, financial assistance recipient, or general adult.
Which RAMQ Dental Services are for Children Under 10?
Children under 10 in Quebec receive a comprehensive range of dental services at no cost from participating dentists. This includes exams, X-rays, certain fillings and crowns, specific endodontic care, anesthesia, extractions, and hospital oral surgery.
Here is a detailed explanation of the services covered by RAMQ for children under 10:
Examinations and Diagnostics: Annual and emergency examinations, as well as X-rays, are fully covered.
Restorative Services: Grey amalgam fillings for premolar and molar teeth are covered. Certain cases allow for fillings using aesthetic materials, primarily for anterior (front) teeth. Additionally, prefabricated crowns and aesthetic material crowns for primary anterior teeth are included.
Endodontic Treatments: Root canal treatments and apexification are covered for permanent teeth. Pulpotomy and pulpectomy are covered only for primary (baby) teeth. For permanent teeth, pulpotomy is covered only when performed under general anesthesia.
Extractions and Surgery: Tooth and root extractions are covered. Frenectomy (the removal of the tongue or lip frenulum) is included. All oral surgery services covered in hospitals for the general population also apply to children.
Anesthesia: Both local and general anesthesia are covered when medically necessary.
A common mistake parents make is assuming that preventive services, such as cleanings, scaling, or sealants, are covered for young children. However, they are not covered. RAMQ does not cover dental cleanings or pit-and-fissure sealants for children under 10 years old.
If your family resides in Ontario or is relocating there, children may qualify for preventive care through Healthy Smiles Ontario, which has rules that differ from those in Quebec.
What Happens to the RAMQ Dental Coverage When a Child Turns 10?
RAMQ dental coverage ends once your child is no longer under 10, unless your family qualifies for financial assistance with a valid claim slip, not at the end of the year or school year.
Therefore, before scheduling any appointments, verify that the dentist participates in the public plan, as not all dentists do. If you see a non-participating dentist, you will need to pay out of pocket for services that would otherwise be covered.
Which RAMQ Dental Services are for Financial Assistance Recipients?
If you have a valid claim slip, your child can access certain dental services through the financial assistance program, which varies based on the duration of consecutive assistance received. For the first 12 months, financial assistance recipients will receive coverage for emergency services only. After 12 consecutive months, you will gain access to basic services. Once you reach 24 consecutive months of assistance, your coverage will also include dentures.
Below are the ways these RAMQ dental services work:
Under 12 Months on Assistance (Emergency Only)
If you have been a recipient of dental services for less than 12 consecutive months, you are eligible only for emergency dental services at a dental clinic. The emergency services covered include:
- Drainage of an abscess
- Dental examination
- Hemorrhage control
- Immobilization of a tooth loosened by trauma
- Opening of the pulp chamber
- Reduction of an alveolar fracture
- Re-implantation of a completely uprooted tooth
- Repair of soft tissue lacerations
- Tooth and root extractions
- Treatment of alveolitis
Regardless, routine exams, fillings, and cleanings are not covered during this phase. If you require a filling for a cavity that is not causing an emergency, you will need to pay out of pocket or wait until you reach the 12-month threshold.
12 to 23 Months on Assistance (Basic Services)
After 12 consecutive months, your coverage expands to include the following services:
- Annual and emergency examinations
- Grey amalgam fillings for premolar and molar teeth
- Fillings using aesthetic materials in certain cases
- Prefabricated crowns
- Local or general anesthesia
- Pulpotomy and pulpectomy for primary teeth
- Tooth and root extractions
- X-rays
- Teeth cleaning and hygiene instruction (for individuals aged 12 and older)
- Scaling (for individuals aged 16 and older)
Note that the age restrictions for cleaning and scaling. If you are under 12, teeth cleaning is not covered, even after reaching the 12-month threshold. Additionally, if you are under 16, scaling is not covered.
From 24 Months on Assistance (Dentures Added)
After 24 consecutive months, coverage for acrylic dental prostheses is available, including:
- Manufacture of a complete or partial acrylic prosthesis (replacement allowed after 8 years).
- Reline every 5 years (minimum of 3 months after receiving the prosthesis).
- Repair of prostheses.
- Replacement of lost or damaged prostheses that cannot be repaired (covered at 50%).
- Replacement of prostheses following oral surgery.
To access denture services, you must obtain written authorization from your local employment center before visiting your participating dentist or denturist. Without this authorization, you will not receive coverage.
Additionally, RAMQ does not cover prostheses on implants or vitallium metal dentures, regardless of how long you have received assistance.
Timing trap: To qualify for 12 or 24 months of assistance, you need to have consecutive months of eligibility. If you get financial help and then come back later, your count of consecutive months may start over, which can slow down your access to basic services and denture coverage.
If you are an Alberta resident seeking family support that may assist with dental expenses, consider the Alberta Child and Family Benefit.
Which Dental Services are not Covered by RAMQ?
Regardless of your age, financial situation, or medical necessity, RAMQ does not cover these services:
- Orthodontics (braces, palate expansion, space maintainers)
- Dental implants
- Periodontics (root planing, gum grafts, periodontal surgery)
- Pit and fissure sealants
- Prostheses on implants
- Recementing of crowns (except for prefabricated crowns)
- Veneers
- Whitening
This policy applies to everyone, and RAMQ cannot reimburse any costs incurred for these services. If you need help covering these, explore dental insurance in Canada.
How RAMQ and the Federal CDCP Work Together
Services covered by RAMQ are not reimbursed by the Canadian Dental Care Plan; however, services not covered by RAMQ may be eligible for CDCP coverage if the client qualifies.
This means that providers must bill RAMQ first for any services covered by RAMQ. The CDCP will not provide coverage, reimbursement, or coordinate benefits for RAMQ-covered services, even if the provider does not participate in RAMQ.
For services not covered by RAMQ and potentially eligible for CDCP coverage, claims can be submitted to Sun Life as long as the client is eligible for CDCP on the date of service.
For example, RAMQ does not cover periodontics for anyone. If you are CDCP-eligible and need gum treatment, you could potentially submit that claim to CDCP. However, if you are a child under 10 needing a filling that is covered by RAMQ, it will be paid for by RAMQ, and CDCP will not cover it.
How to Access RAMQ Dental Coverage in Quebec
To get RAMQ dental services, you should first show your valid Health Insurance Card and claim slip to a participating dentist or denturist in the public plan. If your card has expired, renew it before your appointment; otherwise, you will need to pay out of pocket. Then, present your card to the dentist or denturist to use the service.
Follow these 4 steps to access the plan:
Step 1: Obtain Your Claim Slip (if Applicable)
Your category will determine which services are covered. If you are receiving financial assistance, you will need a claim slip issued by the Ministère de l’Emploi et de la Solidarité sociale. Thus, contact them if you do not have one.
Step 2: Find a Participating Dentist or Denturist
RAMQ dental coverage applies only when services are provided by dentists or denturists who are part of the public plan. It also includes certain independent dental hygienists under a separate RAMQ program. As a result, before receiving treatment, confirm that your provider participates in the plan; otherwise, you should be prepared to pay the provider’s full fee.
Step 3: Present Your Documents at the Appointment
For your appointment, bring your valid Health Insurance Card and claim slip, if applicable. If you are receiving prosthetic services, also bring your written authorization from the local employment center.
Step 4: Request Reimbursement for Covered Services
In Quebec, if you paid for a covered service, you can request reimbursement. Make sure you were eligible for health insurance when the services were provided. Submit your request to RAMQ along with the original invoices and receipts.
Outside of Quebec, RAMQ reimburses dental professional services at amounts not exceeding Quebec rates, and only if those services are also covered in Quebec. You may need to pay upfront and apply for reimbursement with original receipts.
The bottom line
In summary, here are five key takeaways regarding RAMQ dental coverage in Quebec:
- For most adults, RAMQ does not cover routine dental clinic care.
- Children under 10 are eligible for free dental exams, fillings, extractions, and crowns.
- Coverage for claim slip holders varies based on the number of consecutive months enrolled.
- Hospital oral surgery is covered for all insured individuals, regardless of age.
- Orthodontics, implants, and periodontics are not covered by RAMQ at all.
The key thing to understand is that Quebec’s public dental coverage is not a universal benefit. It is specifically intended for young children and individuals receiving financial assistance. If you do not belong to one of these groups, you will be responsible for paying for routine dental care either out of pocket or through private insurance.
Disclaimer: This guide summarizes public coverage rules and is not intended as legal or insurance advice. Benefits may vary based on eligibility and provider participation.
FAQs about RAMQ Dental Coverage in Quebec
Are hospital oral surgery services covered for everyone?
Yes, RAMQ covers some oral surgery services in hospitals for all eligible Quebec residents, regardless of age or financial situation. These include procedures like biopsies, drainage of abscesses, fracture reductions, and removal of cysts or tumours, among others. Exams, anesthesia, and X-rays related to these surgeries are also covered.
What about dental hygienist services in RAMQ dental coverage?
Since June 1, 2023, RAMQ has covered certain dental hygienist services for independent practitioners with an agreement with RAMQ. This coverage applies only to children under 10 and to financial assistance recipients who have had a valid claim slip for at least 12 months. The general population is not eligible.
Is RAMQ dental coverage covered if you receive treatment outside Quebec?
If you get dental services outside of Quebec, they will be covered at Quebec rates, but only if those services are also covered in Quebec. You may need to pay the dentist upfront and then apply to RAMQ for reimbursement, which may be less than you paid.
