What is the Canadian Dental Care Plan?

The Government of Canada is introducing the Canadian Dental Care Plan (CDCP), as part of its objective to make dental care more accessible for families who qualify.

Regular professional, preventive dentistry is proven to reduce the risk of gum disease and tooth decay, which, in turn, can protect against serious health problems, including stroke and cardiovascular disease.

Currently, one-third of people in Canada do not have dental insurance. According to the Government of Canada, in 2022, one-third of Canadians reported avoiding seeing a dental health professional because of financial concerns. To make dental care more affordable and accessible for this group of Canadians, the government introduced a publicly funded dental benefit, which is scheduled to begin covering treatments in May 2024. The CDCP is not intended to provide free dental care for all Canadians, nor to replace existing workplace or private dental benefits.

The plan is being rolled out gradually, and as of April 2024, eligible seniors over age 65 should already have received application letters. Applications will be open to all eligible Canadians by 2025.

In this post, you will learn who is eligible for the benefit, when to apply, and more about the percentage of costs covered. We look at which treatments will be covered, and which will be excluded. We will also answer some of the most commonly asked questions and where to go if you need further help and information.

Who is administering the plan?

The CDCP is a collaboration between Health Canada, Employment Social Development Canada (ESDC), and Sun Life. Sun Life administers the CDCP on behalf of the Government of Canada, by providing dental claims processing services to those who qualify for the program.

Who qualifies for the CDCP?

Anyone wishing to participate in this plan must meet the eligibility requirements outlined below.

• Be a Canadian resident for tax purposes.
• Filed an income tax return for the previous year.
• Do not have dental insurance through a private or pension plan or with an employer.
• Have a net (after tax) family income of less than $90,000 annually.
• Applications for the CDCP are phased, beginning with seniors. Children under age 18 and those with disabilities are eligible starting June 2024. All other Canadian residents can apply starting in 2025.

The table below shows the application schedule.

How much will the CDCP cover?

Provincial and territorial dental associations release fee guides annually that provide their member dentists with recommended service fees. Dentists can choose to charge higher fees based on their clinic's overhead costs, such as rent and payroll expenses. The CDCP has developed their own fee guide, which determines the fees the CDCP will pay for services covered under the plan. These fees can differ from provincial or territorial fee guides. Not all patients will receive complete financial assistance through the CDCP due to required co-payments, so it is important to ask about costs not covered by the plan. These co-payments are the portion of treatment costs you would be expected to cover out of pocket, and the percentage is determined by your family's net annual income shown on the previous year's tax return. Co-payment or fees not covered are paid directly to the dental office.

Table on co-payments based on adjusted family net income. Please note the percentages covered are for the CDCP fee guide, which is sometimes lower than the provincial guides.

Additionally, when a dentist follows their established fee structure, it may be higher than the CDCP’s fees, in which case there is a gap in payments. The gap can be filled by balanced billing, where the patient is billed for the difference between the CDCP fees and the fee their dentist would charge a patient who does not qualify for coverage under the plan.

For example, if a dentist follows the provincial fee guide and charges $100 for a recall dental exam but the CDCP fee structure only covers $90 the patient is responsible for the $10 difference. In the same example, for a patient with a net family income of $85,000, the plan would cover $36 (40% of the CDCP established fee) and the patient would be responsible for $54 (the remaining 60% of the CDCP established fee) plus the additional $10. Please note these figures are for illustration only.

How can people apply?

If you are a senior (age 65 or older), there is no need to do anything, as you will receive a letter with instructions on applying and an application code. You can then apply over the phone by following the instructions included in the letter.

Unfortunately, there are some phishing scams related to the launch of this program. These are being actively investigated by Sun Life and Health Canada, which are administering the plan. You should never be asked for any financial or personal information related to the CDCP. If you are concerned or have questions, contact Service Canada.

If you are eligible but haven't received a letter, check the mailing address used for your 2022 tax filing is current. If your address is out of date, you will need to contact the Canada Revenue Agency (CRA) to update it.

From May 2024, people can apply online. At the time of writing, no information is available on applying online.

Enrollment confirmation

Once you have applied, Health Canada will confirm your eligibility and share your information with Sun Life to enroll you in the plan. You will receive a welcome package from Sun Life within three months of your application, which will include:

• The start date of your coverage.
• Your membership card.
• Information about the CDCP.

Once enrolled, you must meet the eligibility requirements each subsequent year with an annual reassessment. Details about the reassessment process have yet to be released.

How soon will my dental care be covered under the plan?

May 2024 and onwards, your applicable dental treatments will be covered by the plan once you have received confirmation of your enrollment in the plan. Your coverage start date is based on your application, and if you see a dentist before this date, your costs will not be covered.

Ensure your oral health care provider participates in the CDCP when making your appointment.

Are all dental professionals participating in the CDCP?

Although Health Canada encourages oral health providers to enroll in the plan, participation is voluntary. Oral health care providers that can participate in the CDCP include:

• Dentists.
• Dental specialists.
• Dental hygienists.
• Denturists.

Those participating in the CDCP receive direct payment from Sun Life, limiting out-of-pocket costs for patients. When scheduling an appointment confirm with the practice that your oral health care provider has joined this plan and the treatment booked is covered under the plan.

Which dental services are covered?

The CDCP covers oral health services designed to prevent and treat oral disease and to maintain healthy teeth and gums. Services that are covered when recommended by a dental professional can include the following listed below.

• Diagnostic services.
• Dental x-rays.
• Preventive services.
• Periodontal services.
• Restorative services.
• Endodontic services.
• Prosthodontic services.
• Sedation dentistry.
• Oral surgery services.

Diagnostic services

Diagnostic services cover dental examinations and diagnoses. These exams include new patient exams, comprehensive dental exams, recall exams and specific exams. Exams by denturists or dental specialists are not counted against annual exams covered by the CDCP.

Dental X-rays

Digital dental x-rays are 2D images often required to diagnose dental problems or monitor dental health. Various x-rays are available, including those showing just a single tooth and the tooth root and panoramic x-rays showing the complete upper and lower/ arches of teeth.

Preventive services

Preventive services are important for maintaining healthy teeth and gums and reducing the risk of oral disease. These services include scaling (cleaning), polishing, and fluoride. Dental sealants protect the chewing surfaces of permanent molars and premolars in children 17 and under.

Periodontal services; scaling & root planing

Scaling and root planing treats periodontal disease (gum disease), a bacterial infection that can cause tooth loss without proper care. It is done if teeth have significant tartar buildup (mineral deposits) or when the gums have begun pulling away from teeth. Treatment cleans teeth right down to the tooth roots and between the gums.

Restorative Services, including fillings & crowns

Restorative services covered by the plan include dental crowns, post and cores, and fillings. These restorations are provided to protect and preserve existing natural teeth. They are not available for cosmetic purposes. For example, incisal wear and tear are considered cosmetic issues and are excluded from the plan.

Coverage of dental crowns is restricted to teeth that are healthy enough to be restored, and where the damage is significant, so an ordinary filling would provide inadequate support. Crowns to cover dental implants are excluded from the plan. Post and cores are only available for adults aged eighteen or older and only when a crown is preauthorized. The rules surrounding restorative services are complex. If you need these services, your dentist can explain more clearly what is covered, the type of restoration you can receive, and any potential additional costs.

Endodontic services (Root canal therapy)

Root canal treatment can restore severely infected teeth and prevent the need for tooth extractions. Standard root canal therapy does not require preauthorization for all adult teeth where all eligibility criteria are met. The exception is wisdom teeth, which would normally be removed if infected. However, if the first and second molars are missing, the CDCP may cover root canal therapy for wisdom teeth.

Restorability is considered, as a tooth must be suitable for restoration after root canal treatment to be eligible. The CDCP will not cover root canal treatment for people with a high risk of tooth decay or where severe periodontal disease or another rampant biological disease is present.

Prosthodontic services (Dentures)

Prosthodontics uses dental appliances (dentures) to replace one or more missing teeth. Dentures consist of an acrylic, gum-coloured base that rests directly on the gums and supports denture teeth that are shaped and coloured to look natural.

Dentures can be full or partial. Complete or full dentures restore an entire arch of teeth. Partial dentures restore one or more missing teeth in the same arch; these teeth do not need to be adjacent to each other. Partial dentures can be strengthened with a metal framework and may require preauthorization for initial placement.

The CDCP does not cover complete or partial dentures supported by dental implants, or any implant procedures related to denture services.

Sedation dentistry

Sedation dentistry services include minimal, moderate and deep sedation and general anesthesia. Sedation can be useful for children and adults with complex treatment requirements or special needs. Moderate and deep sedation requires preauthorization, and coverage is limited to minimize the potential risks of repeated sessions.

Oral surgery

Oral surgery services covered by the CDCP treat problems affecting the mouth and jaw include:

• Tooth and tooth root removals.
• Surgical removal of cysts and tumours.
• Treating fractures affecting the jawbones.
• Surgical incisions such as those used to drain dental abscesses.
• The plan does not cover dental implant surgery and ridge augmentation.

For additional details on treatment coverage and frequency read this blog.

Which services are not covered by the CDCP?

Coverage under the CDCP is limited to basic services that protect and preserve natural teeth so people can benefit from teeth that function properly. Many people have missing teeth or teeth that are failing and need removing. When this is the case, the CDCP includes the provision of removable dentures, allowing people to eat and talk effectively.

The plan is not designed to improve the overall appearance of teeth or provide purely aesthetic benefits. It also excludes more complex treatments. Treatments not considered/ for coverage under the CDCP include those listed below.

1. Composite resin or porcelain veneers.
2. Three-quarter crowns.
3. Inlays and onlays made from any dental materials.
4. Temporomandibular appliances and therapy.
5. Fixed dental bridges.
6. Teeth whitening.
7. Mouthguards and bruxism appliances.
8. Crown lengthening.
9. Dental implants and any associated treatments.
10. Bone grafting.
11. Precision attachments for partial dentures.
12. Extensive rehabilitation.

Are the types of treatment covered the same for all patients?

Certain services, such as deep sedation, are not covered in all cases. If a provider believes the treatment is medically necessary, they can submit a preauthorization request on behalf of the patient. Approval of the preauthorization request is based on the recommendations of the dental care professional and considers the patient's dental and medical history.

Services that need preauthorization, including coverage beyond the established frequency limitations, will not be covered under the plan until November 2024. If a service is given without preauthorization, for example, if urgent dental care is required, it may be submitted for post-determination beginning November 2024, with no guarantee that the service will be covered.

Treatments requiring preauthorization are listed below.

1. Specialist dental examination.
2. Crowns.
3. Posts and cores.
4. Moderate sedation, deep sedation and general anesthesia.
5. Major surgical procedures.
6. Orthodontic services when clinically necessary (starting in 2025).

FAQs

Will the CDCP Replace Existing Dental Insurance coverage?

The CDCP is designed to provide coverage for Canadians who do not have any existing dental insurance. It is not intended to replace existing insurance plans, and it is important not to cancel any dental plans, as your income tax return may mean you are ineligible for the CDCP. T4/T4A slips show if employees and families had access to dental insurance, including spending and wellness accounts.

What if I need help applying?

If you need help with your CDCP application, you can do so by choosing a trusted person or using a delegate.

Trusted Person

A trusted person can be a relative, friend, caregiver, interpreter or translator. They can help you apply by phone, or you can visit a Service Canada Office. You will need to give clear consent to their help.

Delegate

A delegate is someone with the legal authority to represent you, and they can make decisions on your behalf. A delegate can represent you if they are listed on documents giving them power of attorney, mandates or trusteeships.

A delegate representing you must provide documentation proving they have the legal authority to act for you. They will need certified copies or original documents that must be submitted at a Service Canada office or mailed to Service Canada. Include a cover letter with your full name and Social Insurance Number, the delegate's phone number, and a statement that the documents are being submitted for your CDCP application. You must also include a return address so the documents can be mailed back to you once they are processed.

How does the CDCP fit in with the Canada Dental Benefit?

Parents and guardians paying for dental care for a child under age 12 without private dental insurance can claim through the Interim Canada Dental Benefit scheme until June 30, 2024. The scheme covers treatments until June 30, 2024. The plan is for families earning less than $90,000 annually. The Canada Revenue Agency (CRA) has produced a video walkthrough of this benefit showing how to claim.

In comparison, the CDCP will be available to all eligible Canadians, opening to all age groups by 2025.

Will I qualify if I already receive coverage through a provincial, territorial or federal program?

If you currently access existing Provincial, Territorial or Federal programs and are eligible for the CDCP, then you can apply. According to the Ontario Dental Association, benefits will be coordinated between these programs so care is not duplicated. The details of how this will work exactly are still being refined by the federal government, which is working directly with the provinces and territories.

Will the CDCP replace existing provincial or territorial programs?

The new program is meant to fill in the gaps in dental care provision, not replace existing programs. However, some provinces are reviewing their dental care plans. Some provinces have dental plans that are less generous than the CDCP. If covered, people eligible for provincial or territorial programs should apply to these first but can apply to the CDCP for out-of-pocket costs. Coverage is coordinated to ensure there are no gaps or duplications.

Can my dependents also benefit from the CDCP?

Anyone who meets the eligibility requirements for the CDCP (and is part of an eligibility group that has begun receiving invitations to apply) may apply for the program. If your dependents meet the eligibility requirements, then they are eligible. Parents may apply on behalf of their children once they are eligible in June 2024.

Will the entire cost of my dental treatment be covered under the new plan?

As the CDCP is not a fully subsidized program, there may be some out-of-pocket costs when you receive treatment. These additional costs stem from three factors:

1. The fees covered by the CDCP are generally lower than the recommended fees for dental care in some provinces.
2. Those with an adjusted family net income between $70,000 and $89,999 will have a copayment, meaning only a set percentage of fees will be covered.
3. Not all dental services will be covered by the CDCP.

Conclusion

The CDCP is a new program, and while it is welcomed, it is important to understand its benefits and limitations.

It is currently unknown how many oral health care providers will accept CDCP coverage as payment and how much more affordable dental care will be for eligible families earning more than $70,000 annually.

Oral care is an important aspect of good overall health and expanded access to care could have an important impact on the health of Canadians.

While we strive to provide accurate and comprehensive information in this blog post, the CDCP may undergo updates or changes over time. For the most current and precise details regarding the plan, please visit the program website.

*While we strive to provide accurate and comprehensive information in this blog post, the CDCP may undergo updates or changes over time. For the most current and precise details regarding the plan, please visit the program website.