As part of its goal to enhance access to dental care for eligible families, the Canadian government is launching the Canadian Dental Care Plan (CDCP).
Consistent professional preventive dental care has been shown to lower the chances of developing gum disease and tooth decay. This, in turn, helps prevent serious health issues such as stroke and cardiovascular disease.
Currently, 33% of individuals in Canada lack dental insurance. As per the Government of Canada, in 2022, 33% of Canadians refrained from visiting a dental professional due to financial worries. To enhance affordability and accessibility of dental care for this demographic, the government initiated a publicly funded dental benefit program, set to commence treatment coverage in May 2024. The CDCP aims not to offer complimentary dental services to all Canadians or supplant existing workplace or private dental benefits.
The plan is currently being implemented in phases, and by April 2024, application letters should have been sent to seniors over the age of 65 who are eligible. By 2025, all eligible Canadians will be able to apply.
Who is in charge of managing the plan?
The CDCP is a partnership involving Health Canada, Employment Social Development Canada (ESDC), and Sun Life. Sun Life is responsible for managing the CDCP on behalf of the Government of Canada, offering dental claims processing services to eligible program participants.
Who qualifies for the CDCP?
To qualify for the Canadian Dental Care Plan, you must meet the following criteria:
Be considered a Canadian resident for tax purposes.
Have filed an income tax return for the previous year.
Not have dental insurance through a private or pension plan or provided by an employer groups.
How much will the CDCP cover?
Eligible Groups | Date Applications Open |
Seniors aged 87 and older | December 2023 |
Seniors aged between 77 and 86 | January 2024 |
Seniors aged between 72 and 76 | February 2024 |
Seniors aged between 70 and 71 | March 2024 |
Seniors aged between 65 and 69 | May 2024 |
People holding a valid Disability Tax Credit Certificate | June 2024 |
Children under the age of 18 | June 2024 |
All other eligible Canadian citizens and residents | 2025 |
Each year, provincial and territorial dental associations publish fee guides that offer suggested service fees to their member dentists. Dentists have the option to set higher fees taking into account their clinic's operational expenses, such as rent and staff wages. The CDCP has introduced its own fee guide to determine the rates it will reimburse for services included in the plan. These rates may vary from those in provincial or territorial fee guides. Not all individuals will receive full financial aid via the CDCP due to required co-payments, so it is crucial to inquire about expenses not covered by the plan. Co-payments represent the share of treatment costs that individuals are expected to pay out of pocket, and the percentage is determined by the net annual income of their household as indicated in the previous year's tax return. Co-payments or uncovered fees are settled directly with the dental clinic.
Chart illustrating co-payment rates based on adjusted family net income. Please bear in mind that the coverage percentages are based on the CDCP fee guide, which may be lower than those in provincial guides.
Net Family Income | % Covered by the CDCP | % Covered by Patient |
Below $70,000 | 100 | 0 |
$70,000- $79,999 | 60 | 40 |
$80,000 – $89,999 | 40 | 60 |
Moreover, if a dentist adheres to their predetermined fee schedule, it might exceed the CDCP's charges, resulting in a payment disparity. This discrepancy can be addressed through balanced billing, where the patient is invoiced for the variance between the CDCP rates and the fees that their dentist would typically bill a patient not covered by the plan.
For instance, if a dentist abides by the provincial fee guidelines and bills $100 for a routine dental check-up, while the CDCP fee structure only accounts for $90, the patient is accountable for the $10 disparity. In the same scenario, for a patient with a household income of $85,000, the plan would cover $36 (40% of the CDCP's established fee), leaving the patient responsible for $54 (the remaining 60% of the CDCP's established fee) plus the additional $10. It is essential to note that these amounts are purely for illustrative purposes.
How can people apply?
If you are 65 years old or older, you will automatically receive a letter containing instructions and an application code. You can then proceed with applying over the phone as per the instructions provided in the letter.
It is important to be aware of potential phishing scams associated with the program launch. Sun Life and Health Canada, the program administrators, are actively investigating these scams. Remember that you should never disclose any financial or personal information regarding the CDCP. If you have concerns or questions, reach out to Service Canada.
If you are eligible but have not yet received a letter, ensure that your mailing address matches the one used for your 2022 tax filing. If your address needs updating, contact the Canada Revenue Agency (CRA).
Starting from May 2024, individuals also have the option to apply online. The online application is available on the https://www.canada.ca/en/services/benefits/dental/dental-care-plan/apply.html#apply-online.
Confirmation of enrollment
After submitting your application, Health Canada will verify your eligibility and pass on your details to Sun Life for enrollment in the plan. You can expect to receive a welcome package from Sun Life within three months of applying, containing:
The effective date of your coverage.
Your membership card.
Information regarding the CDCP.
Once you are enrolled, you will need to meet the eligibility criteria each year through an annual reassessment. Further information about the reassessment procedure is yet to be disclosed.
When will my dental care be included in the plan?
Starting from May 2024, your eligible dental procedures will be included in the plan after you have been officially enrolled. The coverage will begin according to your application date, and any dental visits prior to this date will not be reimbursed.
Make sure your dental care provider is a part of the CDCP before scheduling your appointment. At Lux Dental we are accepting CDCP patients.
Are all dental professionals participating in the CDCP?
Even though Health Canada recommends that oral health providers join the program, it is optional to participate.
What dental services are included in the coverage?
The CDCP includes oral health services aimed at preventing and treating oral diseases while promoting healthy teeth and gums. Covered services, recommended by a dental professional, may encompass diagnostic services, dental x-rays, preventive care, periodontal treatments, restorative procedures, endodontic care, prosthodontic services, sedation dentistry, and oral surgery services.
Which services are not covered by the CDCP?
The CDCP provides coverage for essential services aimed at maintaining and safeguarding natural teeth to ensure proper functionality. Individuals with missing or deteriorating teeth may receive removable dentures through the CDCP to support effective eating and communication.
It is important to note that the CDCP does not cater to enhancing the cosmetic appearance of teeth or offering purely aesthetic advantages. Additionally, the plan does not cover more intricate treatments. Excluded treatments under the CDCP encompass:
Composite resin or porcelain veneers.
Three-quarter crowns.
Inlays and onlays using any dental materials.
Temporomandibular appliances and therapy.
Fixed dental bridges.
Teeth whitening.
Mouthguards and bruxism appliances (night guards).
Crown lengthening.
Dental implants and associated treatments.
Bone grafting.
Precision attachments for partial dentures.
Extensive rehabilitation.
Do all patients receive the same types of treatment coverage?
Some services, such as deep sedation, may not be covered in all instances. If a provider deems the treatment medically necessary, they can request preauthorization on behalf of the patient. The approval of the preauthorization request is based on the recommendations of the dental professional and takes into account the patient's dental and medical history.
Services requiring preauthorization, which includes coverage exceeding the established frequency limits, will not be covered by the plan until November 2024. If a service is provided without preauthorization, such as in cases of urgent dental care, it can be submitted for post-determination starting November 2024, with no assurance of coverage.
Below are the treatments that necessitate preauthorization:
Specialist dental examination.
Crowns.
Posts and cores.
Moderate sedation, deep sedation, and general anesthesia.
Major surgical procedures.
Orthodontic services when deemed clinically necessary (effective from 2025).
Is the CDCP going to substitute current dental insurance plans?
The CDCP is meant to offer coverage for Canadians without current dental insurance. It is not meant to be a substitute for current insurance plans, and it's crucial not to terminate any dental plans, as this could make you ineligible for the CDCP based on your income tax return. T4/T4A slips indicate whether employees and their families had dental insurance, along with details on spending and wellness accounts.
Will my dental treatment be fully covered by the new plan?
Since the CDCP is not fully funded, there may be certain expenses that you will need to pay for when undergoing treatment. These extra costs arise from three main factors:
The charges included in the CDCP are generally lower than the recommended fees for dental services in specific provinces.
Individuals with a family net income adjusted between $70,000 and $89,999 will be required to make a copayment, where only a fixed percentage of the fees will be covered.
Some dental procedures may not be covered by the CDCP.
Conclusion
Although the CDCP is a new initiative that is being well-received, it is crucial to grasp both its advantages and limitations.
The extent to which oral health care providers will accept CDCP coverage as payment and the potential cost savings for eligible families earning over $70,000 annually remain uncertain.
Dental care is a critical component of overall well-being, and increased access to services could significantly benefit the health of Canadians.
While we aim to offer accurate and thorough information in this blog post, it is important to note that the CDCP may undergo updates or modifications in the future. For the most up-to-date and precise details about the program, please visit the official website.
Utilize the Canadian Dental Care Plan (CDCP) at Lux Dental. Get in touch with us to arrange your appointment and begin your path to a healthier smile. Reach out to us today or visit our website to make an online reservation. We are excited to assist you!
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