Queen Street Family Dentistry
Dental care has long presented a significant gap in the Canadian healthcare system. While most routine medical examinations and procedures are covered under provincial healthcare plans, such as OHIP, Canadians have had to rely on private insurance plans to meet their dental needs or pay out-of-pocket. For low-income Canadians and those without traditional workplace benefits (or a group plan from an insurance company), this system created significant barriers to oral health care, leaving millions without reliable access to essential services.
What is the Canadian Dental Care Plan (CDCP)? A Dental Benefits Guide
The CDCP is a new Canadian dental care plan that aims to help low-income families by providing government-subsidized dental care to uninsured Canadians with an annual household income below $90,000. Unlike government-funded healthcare programs, the CDCP is not intended to provide coverage or replace private insurance plans for individuals who already receive coverage via their school, workplace, or a private plan. Instead, it is meant to support individuals who do not have any form of private dental insurance.
In the following guide, we will outline CDCP eligibility in 2024, answer questions about the CDCP, and discuss how to receive coverage.
Why is the Canadian Dental Care Plan Important? How the CDCP will Help Canadians Get the Care They Need
Dental care isn’t a luxury; it’s a necessity. Receiving timely dental care is crucial to preventing chronic pain, gum disease, tooth loss, and potentially life-threatening infections. Likewise, having an aesthetically pleasing smile plays a role in many of life’s major milestones: job interviews, professional events, and social situations are easier when one feels confident smiling. Providing low-income Canadians with these advantages ensures equal access to opportunities and supports poverty reduction.
Dental health is also closely linked to overall health; expanding coverage will lower the risk of chronic diseases (such as diabetes and heart disease) in the general population. By improving access to a range of oral health care services, we can improve individual health outcomes while alleviating pressure on our healthcare system by preventing more serious medical issues from developing. This benefit is especially critical at a time when emergency rooms across Canada are struggling with staff shortages and increased wait times. For these reasons, the CDCP is widely supported by the Canadian Dental Association, the Ontario Dental Association, and other provincial and territorial dental associations.
Canadian Dental Care Plan Eligibility in 2024-2025
Currently (as of 2024), the CDCP is open to Canadians without dental care coverage (and an adjusted annual family net income below $90,000) who meet the following criteria:
-Older Canadians. (Senior individuals aged 65 years and up).
-Adults with a valid disability. (A disability tax credit certificate is required.)
-Children under 18.
Starting in 2025, remaining eligible Canadian residents with an annual household income below $90,000 can apply for oral health care services from the CDCP. If you are eligible for participation in the CDCP, your care team will be able to direct bill Sun Life for part (or all) of the cost of your care.
How to Apply for the Canadian Dental Care Plan
Those who are eligible for CDCP coverage can apply online via Service Canada. The application process is simple and typically takes less than half an hour. Because the CDCP is managed by Health Canada and administered by Sun Life insurance, those who are successfully enrolled in the CDCP will receive a welcome package from Sun Life after enrolment (and your oral care provider will bill Sun Life for services provided). This package includes a member card, co-payment information, and the date coverage begins.
Can You Apply for the CDCP Canada Dental Benefit if You Have Existing Dental Coverage?
Canadians who already have dental coverage via their workplace, school, or private insurance cannot currently apply for the CDCP. However, if your coverage situation changes, you may meet the eligibility criteria for the CDCP at a later time. Talk to your dentist if you lose your current dental insurance coverage and wish to review your CDCP eligibility.
What is Covered by the CDCP?
The CDCP is designed to provide care for eligible Canadian residents without access to dental insurance, but it is not a free dental program. It consists of different dental benefit grids based on household income. Those with an adjusted family net income above $70,000 who meet all the eligibility criteria will still need to pay for a portion of their care, with individuals earning between $70,000 and $79,999 paying 40% CDCP fees, and those earning $80,000 to $89,999 paying a 60% co-payment of the CDCP benefit. Households with a family net income of less than $70,000 will not have a co-payment. Additionally, patients will have to pay for services not covered by the government, such as cosmetic dental procedures.
However, the new dental program will significantly reduce, or even eliminate, the cost of many routine oral care procedures for those without employer-provided dental coverage or private dental benefits. Some of the various dental care services the CDCP covers include:
-Professional dental cleanings, including tooth scaling and polishing.
-The application of dental sealants and fluoride.
-Diagnostic services, including examinations and dental X-rays.
-Restorations, such as dental fillings and root canal treatments. Crowns will also be covered, but require pre-authorization.
-Treatments for periodontal disease.
-Removable dentures (both complete and partial).
-Limited orthodontic services, including braces (to be added in 2025).
-Certain oral surgery procedures, such as tooth extractions and removal of oral tumors.
What Role do Dentists Play in CDCP Coverage & Who is Eligible for the CDCP Government Dental Benefit?
Dental professionals cannot influence which services are covered (or not covered) under the plan because the CDCP is a Government of Canada program. However, your oral health provider can help you understand which dental services are covered under the CDCP care program and plan the best course of treatment to meet your needs. Where required, your dentist can also pre-authorize specialized services provided under the plan and advocate on your behalf. For this reason, we recommend establishing a relationship with a caring, experienced dental team before applying for coverage under the CDCP. Likewise, because not all dental offices are participating in the new federal government program, it is crucial to find a CDCP provider if you plan to receive care covered by the plan.
Choose Queen Street Dentistry as Your Oral Health Provider
If you are eligible for coverage under the Canadian Dental Care Plan, the experts at Queen Street Dentistry can explain how this new type of dental care insurance will help you. We can also secure pre-authorization for essential treatments and find ways to maximize your benefits. If you don’t currently qualify for the CDCP dental care program, we can provide you with affordable preventative dental care, protecting your smile – and overall health – until you receive coverage. Remember, it is critical not to delay regular dental exams until the new dental plan begins.
Contact Queen Street Dentistry today to book a dental appointment and discover how we can help you achieve a brighter, healthier smile.