Reviewed June 22, 2026 · Health and dental plans for Canadians outside Quebec.
Look closely at your health and dental plan and you will find a set of fixed dollar figures: a dental maximum, a drug cap, a limit per paramedical practitioner. Here is the catch almost no one mentions at sign-up — those numbers usually do not move, while the cost of the care they cover climbs every year. Over time, the same maximum quietly buys less. Here is why, and what to do about it.
Is this you?
- You noticed your dental coverage runs out faster than it used to.
- You are choosing a plan and unsure how much the maximums really matter.
- You have had the same plan for years and want to know if it has fallen behind.
If any of those fit, read on.
Maximums are fixed; prices are not
Most maximums in a health and dental plan are fixed dollar amounts written into the contract. A dental maximum, a drug cap, a limit on physiotherapy visits — each is a specific number. Unless the plan explicitly says a maximum is indexed to inflation, it stays that number year after year.
Meanwhile, the cost of the care keeps rising. So without anything in your plan changing, the real value of each maximum shrinks a little every year. The plan did not get worse; the world around it got more expensive.
Dental is the clearest example
Provincial dental associations publish suggested fee guides that generally rise each year. The cleaning, filling, or crown that fit comfortably under your dental maximum a few years ago now costs more — but if your annual dental maximum stayed flat, it simply covers fewer procedures than it once did. That is why a maximum can feel like it is shrinking even though the number on the page never changed.
Annual vs. lifetime maximums
Not all maximums erode equally, so know which kind you have:
- An annual maximum resets every plan year. Inflation nibbles at it, but you get a fresh maximum each year.
- A lifetime maximum is a single ceiling that never resets — common for things like orthodontics or certain higher-cost benefits. These are the ones inflation hits hardest, because a limit set years ago gets spent in today's pricier dollars, and once it is gone, it is gone.
What actually erodes — and what does not
- Most affected: flat drug caps, annual dental maximums, and especially lifetime limits.
- Less affected: benefits expressed as a percentage (say, 80% of a cost) rather than a fixed dollar amount, since the reimbursement scales with the bill — though even these can sit under an overall dollar cap.
Reading your plan for which limits are fixed dollars and which are percentages tells you where the quiet erosion is happening.
How to keep your coverage from falling behind
- Review your maximums once a year, ideally at renewal. Does the drug cap still cover a full year of your prescriptions? Does the dental maximum cover your usual treatment?
- Watch lifetime limits. If one is close to used up, know that before you need the benefit.
- Match the maximum to your real spending. If you never come near your maximums, paying for bigger ones is wasted premium. If you routinely hit the ceiling, a higher maximum can be worth far more than the extra premium.
- Re-shop when you renew. A different plan or a higher tier may offer maximums that fit today's prices at a similar cost.
The bottom line
A plan maximum is a promise fixed in yesterday's dollars, and yesterday's dollars stretch a little less each year. That is not a reason to panic — it is a reason to look at your maximums against real prices at least once a year and adjust if they have fallen behind.
The quickest way to see whether better maximums are available for a similar premium is to compare plans side by side for your age and province. It takes about two minutes and needs no contact information.
Get Health Coverage is an independent comparison platform for individual health and dental insurance. We do not sell insurance and take no commission — plans are ranked by price. Coverage details, maximums, and rates are set by each carrier and confirmed at application. Coverage is available in every province and territory except Quebec.
Frequently asked questions
Do health and dental plan maximums increase with inflation?
Usually not automatically. Most annual and lifetime maximums are fixed dollar figures written into the plan — a dental maximum, a drug cap, a paramedical limit per practitioner. Unless the plan specifically says a maximum is indexed, it stays the same number year after year while the cost of care rises. That means the same maximum covers a little less each year in real terms. When you renew or shop, it is worth checking whether the maximums still match today's prices.
Why does my dental maximum feel smaller than it used to?
Because dental fees generally rise each year while your dental maximum likely stayed flat. Provincial dental associations publish suggested fee guides that tend to increase annually, so the same cleaning, filling, or crown costs more over time. If your plan's annual dental maximum has not moved, it now covers fewer procedures than it did when you signed up — not because the plan changed, but because the prices around it did.
What is the difference between an annual and a lifetime maximum?
An annual maximum resets every plan year — for example, a dental maximum you get again each year. A lifetime maximum is a single ceiling that, once reached, is gone for good; these often apply to specific benefits like orthodontics or certain higher-cost items. Lifetime maximums are the ones most eroded by inflation, because a figure set years ago is spent in today's more expensive dollars. Always check which type each maximum is.
How do I keep my coverage from falling behind?
Review your maximums against real prices at least once a year, ideally at renewal. Ask whether the drug cap still covers a full year of your prescriptions, whether the dental maximum covers your typical treatment, and whether any lifetime limits are close to being used up. If a maximum has fallen behind, moving to a higher tier or a different plan may restore the protection. Comparing plans is the quickest way to see whether better maximums are available at a similar price.
Are higher maximums always worth paying more for?
Not always — it depends on your actual usage. If you rarely approach your current maximums, paying for higher ones is wasted premium. If you routinely hit the ceiling on drugs or dental, a higher maximum can be worth far more than the extra premium costs. The honest answer is to match the maximum to what you actually spend, then compare plans on price for that level of coverage rather than buying the biggest numbers by default.