What you need to know
The Canadian Dental Care Plan (CDCP) is a new federal program that aims to improve access to oral health care for Canadians who do not have dental insurance and have a household income below $90,000. The program will cover some of the costs of various dental services, such as exams, cleanings, fillings, extractions, and root canals. 1
The CDCP is expected to benefit millions of Canadians who currently face financial barriers to getting the dental care they need. According to a 2019 report by the Canadian Dental Association, about 32% of Canadians have no dental insurance, and 21% of Canadians avoided visiting a dentist in the past year because of the cost. 2
The CDCP will be implemented in phases, starting with seniors aged 87 and above in December 2023, and gradually expanding to other groups, such as adults with disabilities, children under 18, and seniors aged 65 to 69, by June 2024. The program will be fully available to all eligible Canadians by 2025. 1
To apply for the CDCP, eligible Canadians will receive a letter from Service Canada with a personalized application code and instructions on how to apply online, by phone, or in person. Once approved, they will receive a CDCP card that they can present to participating oral health care providers to receive the covered services. 1
However, the CDCP is not without challenges and uncertainties. The programs fees are lower than the current provincial fee guide and recommendations as set by the Ontario Dental Association by about 20-40% depending on the fee category. The program also does not cover all dental services, such as crowns, bridges, implants, braces, and cosmetic procedures. Moreover, it is unknown how the federally administered program will work with existing provincial programs. Our office utilizes electronic claims submissions and at this point the electronic portal isn’t ready.
As your family dentist, we have a responsibility to perform the best dentistry possible for you and your family and we are hoping the program is able to maintain our standards.
At this point, we are still waiting for the government to provide more answers and guidance before accepting the CDCP. We will keep you updated on the latest developments and information as they become available.
What is covered by the CDCP?
The CDCP will help cover a wide range of oral health care services that prevent and treat oral health issues and diseases. Examples of services that could be covered under the CDCP when recommended by an oral health provider, include:
- preventive services, such as scaling (cleaning), polishing, sealants, and fluoride
- diagnostic services, such as examinations and x-rays
- restorative services, such as fillings
- endodontic services, such as root canal treatments
- prosthodontic services, such as complete dentures and partial removable dentures
- periodontal services, such as deep scaling
- oral surgery services, such as extractions
- orthodontic services that would improve oral health outcomes for eligible clients (available starting in 2025)
Some oral health care services will require preauthorization, which means that prior approval is required from the CDCP before the treatment is provided, to confirm that it will be covered under the plan. These services include:
- major restorative services, such as crowns and bridges
- implant-supported prosthodontics
- complex oral surgery services, such as surgical removal of impacted teeth
- orthodontic services
Preauthorization services will be available starting in November 2024. 5
The CDCP will only pay for oral health care services covered within the plan at the established CDCP fees. These fees are not the same as the provincial and territorial oral health associations suggested fee guides that providers often use to charge for oral health services. People covered under the CDCP may have to pay any additional charges directly to the oral health provider. 5
What is not covered by the CDCP?
The CDCP does not cover any dental procedures related to non-eligible dental services, nor does it cover dental procedures related to a dental service reviewed by the CDCP where it did not meet the established policies, guidelines, and criteria. Some examples of non-eligible dental services are:
- temporomandibular joint (TMJ) therapy and appliances
- extensive rehabilitation and cosmetic services, such as veneers, whitening, and bonding
- sports mouth guards and night guards
- snoring and sleep apnea appliances
- sedation services, except for nitrous oxide
- services provided in a hospital setting
- services provided outside of Canada
These services are defined as exclusions and will not be considered for coverage or for an appeal at any time. 6
What are the eligibility criteria for the CDCP?
To qualify for the CDCP, you must meet all the following eligibility criteria:
- not have access to dental insurance through any other source, such as your employer, your pension, or a private plan
- have an adjusted family net income of less than $90,000
- be a Canadian resident for tax purposes
- have filed your tax return in the previous year
Your adjusted family net income is calculated as follows:
- your family net income (line 23600 of your tax return plus line 23600 of your spouse’s or common-law partner’s tax return, and any world income not reported in a tax return to the CRA, such as by a new resident)
- minus any universal child care benefit (UCCB) and registered disability savings plan (RDSP) income received (line 11700 and line 12500 of your or your spouse’s or common-law partner’s tax return)
- plus any UCCB and RDSP amounts repaid (line 21300 and line 23200 of your or your spouse’s or common-law partner’s tax return)
You need to meet all the eligibility criteria to qualify for the CDCP. 7
What are the co-payments for the CDCP?
You may have a co-payment based on your adjusted family net income. A co-payment is the percentage of the CDCP fees that is not covered by the CDCP, and that you will have to pay directly to the oral health provider. Your co-payment is based on your adjusted family net income as follows:
- if your adjusted family net income is lower than $70,000, the CDCP will cover 100% of the eligible oral health care service costs at the CDCP established fees, and you will not have a co-payment
- if your adjusted family net income is between $70,000 and $79,999, the CDCP will cover 60% of the eligible oral health care service costs at the CDCP established fees, and you will have a co-payment of 40%
- if your adjusted family net income is between $80,000 and $89,999, the CDCP will cover 40% of the eligible oral health care service costs at the CDCP established fees, and you will have a co-payment of 60%
You may also have to pay additional charges directly to the oral health provider, if:
- your oral health provider charges more than the established CDCP fees, or
- you and your oral health care provider agree to services that the CDCP does not cover
You will need to pay the full cost of these services if you receive them.
What does the Ontario Dental Association think of the CDCP?
The CDCP is intended to help millions of people without dental benefits access essential oral health care. Although this is an historic investment, the CDCP has been developed under tight timelines and with limited involvement of practicing dentists. It is critical that the government has a full understanding of the impact it will have on patients trying to access the program.
Now that more details of the CDCP have been released, it’s time for the federal government to answer the big questions Canadians have:
- Am I getting free dental care? No – patients may pay out-of-pocket for services and fees that aren’t covered under the federal government’s new dental benefits plan, including 40 to 60 per cent co-payments for families who earn more than $70,000 per year. Where government reimbursement does not cover the full cost of care, some patients will pay the balance.
- Can I choose my own dentist? Maybe not – patients will have to search for dentists who agree to participate, despite the unclear terms and conditions set by the government.
- Will it be easy to get the care I need? Maybe not – dentists expect there will be a lot of red tape that may delay care and not make this a smooth process. Unlike other dental benefits programs, the CDCP has inserted processes that get in the way of how patients can access essential oral health care, and the relationship they have with their dentist.
The federal government has not answered other critical questions: How will they protect existing work, school and/or group dental benefits? How will the CDCP work with other publicly funded dental programs, including provincial programs? Without addressing these legitimate concerns, how do they expect people to know what this will mean for their dental coverage and what they should do next?
As experts in oral health care, the dental associations, representing over 25,000 dentists across the country, have pointed out that the CDCP does not meet most of the principles of our proposed framework. This is an historic investment, so it is critical that the federal government truly gets it right.
To learn more, read our latest media release.
