The Canadian Dental Care Plan: What you need to know

What Do I Need to Know about Dental Care in Canada?

Proposed in 2022, the Canadian Dental Care Plan (CDCP) was formally announced in 2023. 

The CDCP is intended to help millions of people without dental benefits access essential oral health care. While the Canadian Association of Retired Persons (CARP) applauds the intention to provide essential oral care to those who need it, we must get the details right. An historic investment and an ambitious undertaking, the details of the dental plan’s implementation have continued to evolve since the plan was first announced. The Canadian Association of Retired Persons (CARP) is pleased to see that dialogue between the government and the Canadian Dental Association (CDA) has been productive in improving the public plan.

Here are key elements CARP wants to be sure its members are aware of.

 Understanding the Canadian Dental Care Plan (CDCP)

While the Canadian Dental Care Plan (CDCP) offers some coverage for dental care, not all dentists are participating in the CDCP and not all patients will have the full cost of their appointments covered. In a nutshell, here’s what you need to know:

 – Before booking an appointment with a dentist of your choice, please ask if the dentist is participating in the CDCP program and if they direct bill Sun Life for services provided under the plan.

Co-Payments: If your adjusted family net income is between $70,000 and $89,999, you may need to pay a portion of your dental costs. The federal government covers only a part of the fees, leaving the remaining costs, known as co-payments, to you.

Below is the co-payment breakdown based on adjusted family income.

In addition to the co-payment requirements listed above, many of the established fees covered by the federal government do not meet the full cost of the treatment in a dental office. The difference will be on you.

Additional care is not available until the fall

Limited dental care options are currently available to patients until preauthorization starts in November 2024. Preauthorization is a process where prior approval is required before the treatment can be provided to the patient. This preauthorization is based on a treatment recommendation from a dentist and must be approved by the government to proceed.

Until preauthorization begins, eligible patients can access care up to certain frequencies and only for certain procedures. The Government of Canada website has more information on this, but we encourage patients to speak with their dentist before their next appointment to avoid any surprises at the time of the appointment.

CDCP welcome packages will provide start dates

Your CDCP welcome packages may take up to three months to arrive from the time you apply and enrol. Your coverage start date will be laid out in your welcome package and may vary based on when you apply and when your application is processed. This means that you cannot receive care under the program until you have received your CDCP card and observed your start date. Appointments can only be scheduled on or after your coverage start date.

General Eligibility Criteria

  – You must have no access to a dental plan (e.g., through an employer, pension, or private insurance).

  – Your adjusted annual family net income must be less than $90,000.

  – You must be a Canadian resident for tax purposes and have filed a tax return in the previous year.

– Existing Coverage: If you already have dental coverage through a provincial, territorial, or federal program, you may still qualify for CDCP if all eligibility criteria are met. Your coverage will be coordinated to avoid duplications or gaps.

– Important Reminder: The CDCP is not intended to replace existing dental coverage. Do not drop your current coverage, as you may not be eligible for CDCP if you do.

This information is from the Canadian Dental Association.

How is CARP Advocating?

CARP is continuing to follow the negotiations between the governments, provinces and Dental Associations closely.  CARP’s discussions with the Dental Association, elected officials and public servants make clear there are still unanswered questions.  

CARP will continue to press the government to address legitimate concerns. 

CARPs concerns include:

• What will be covered? There is still not full clarity on precisely what will be covered, but the government has provided information about dental services that “could” be covered.
• Provinces Opting Out: Alberta and Quebec have opted out. However, for now Alberta’s intent to opt out does not change your Alberta provincial dental care coverage or the CDCP; you will not lose your provincial coverage if you access the CDCP.
• Will the Promise Hold for Long-term Care Residents?: CARP continues to advocate for mobile health services across the nation in which dental hygienists can bill the government directly for their services, enabling dental care for residents in long-term care facilities. While this has been promised, we don’t yet have details on its implementation. CARP is continuing to advocate with provincial governments to make sure this aspect of the dental program is implemented.
• Taxes: CARP understands that support will be contingent upon having filed taxes. Those who do not need to pay taxes, on account of their very low incomes, do not always file taxes.  We encourage everyone to file taxes, and this adds impetus given it will enable those eligible for the dental care support to receive it.
• Older Canadians may Delay Treatment due to Confusion about Coverage: Please don’t delay treatments or your dental appointments. It’s better to keep getting regular dental checkups now to catch problems before they become painful and expensive to treat.
• Third Party/Private insurance exclusion: CARP has been vocal about concerns regarding whether seniors existing plans disqualify them from the public plan.  Recently the government made some clarifications and an exception. CARP is urging the government to do better.

• • Those who purchased private dental insurance plans on their own will qualify for the national program — but only after their existing private policies are no longer in effect. Given the lack of clarity, opting out of private insurance in order to qualify for a yet-to-be finalised plan could leave seniors without any coverage.

  • Those with access to private dental coverage through their work or professional organizations remain ineligible for the Canadian Dental Care Plan. They’re ineligible even if they decided to opt out of their private insurance, haven’t made a claim, or have to pay a premium. CARP knows many seniors are struggling with the cost of their insurance. Why won’t the CDCP allow these seniors to opt out of their private plans and join the federal dental plan?

  • The government has made an exception for retirees who decided not to sign up for private dental insurance offered specifically through their pension plans. If they opted out of those pension dental plans before Dec. 11, 2023, and aren’t allowed to opt back in, they qualify for the national program.