By Olev Edur
Here’s your guide to what we know (and don’t yet know) about the new national dental-care plan
Starting this spring, and after much anticipation and speculation, low- and middle-income Canadian seniors will finally have access to a nationwide government-sponsored dental plan. And given the details released in December 2023, the Canadian Dental Care Plan (CDCP) may be much more generous than it was once expected to be.
That’s because, unlike the interim Canada Dental Benefit (CDB) introduced last year for children under 12, which was restricted to one or possibly two (depending on income) $650 limits per claimant per year, there are no overall dollar limits per se for the CDCP, although there may be other limits.
“There’s no annual or lifetime maximum spending amount for those covered under the plan,” says Nicholas Janveau, communications officer with Health Canada and the Public Health Agency of Canada. However, he adds, “there will be established frequency limits.”
“In some cases, these frequency limits could be exceeded, with preauthorization or advance approval, based on medical need,” he explains. “The CDCP focuses on what is medically necessary by the recommendation of an oral-health-care provider, with built-in flexibility to meet broad needs. And as part of a continuous-improvement approach, the CDCP will be reviewed regularly based on data and evidence to ensure that it meets the needs of Canadians.”
So, while the absence of dollar limits is undeniably good news, many questions about the plan do still remain, including the exact nature of those “frequency limits.” And as discussed below, the application process seems to be a bit more complicated than perhaps was originally envisioned.
Who qualifies for coverage?
CDCP coverage will be available only to those who have no access to private dental-care insurance and who have an adjusted net family income of $90,000 or less. (Married/ common-law couples must include both partners’ incomes in the calculation.) However, applicants who have access to dental-care benefits through government programs may still apply for the CDCP, provided they meet all the other eligibility criteria.
“Adjusted” net income is defined as net income per line 23600 of your tax return, minus net income from registered disability savings plans (these appear on lines 12500 and 23200), minus net universal child-care benefits (these, on lines 11700 and 21300, will likely apply to few if any retirees), plus any worldwide income not reported to the Canada Revenue Agency (CRA).
Those with incomes below $70,000 will receive 100 per cent coverage of eligible oral-health-care services (based on the CDCP’s fee schedule). Those with incomes from $70,000 to $79,999 will receive 60 per cent coverage, while those with incomes from $80,000 to $89,999 will receive 40 per cent coverage; the balance (40 or 60 per cent, respectively) will have to be paid out of pocket.
By the time you read this article, all qualifying seniors aged 70-plus should have received letters from Service Canada containing a personalized application code and instructions on how to apply for the CDCP. At present, applications must be made by phone, although an online application portal is scheduled to become available start- ing in May. Seniors aged 65 to 69 should receive their letters in May; adults with a valid Disability Tax Credit certificate and children under age 18 should receive theirs in June, while those aged 18 to 65 will have to wait until sometime in 2025.
Your letter will be sent to the address you used in your 2022 tax return, and only if you have an adjusted net family income of less than $90,000. If you haven’t filed a 2022 tax return or your address is out of date, you may not receive a letter in the mail. In such cases, you should contact the CRA now to see about belatedly filing that return or updating your personal information. (Applicants will be reassessed every year to confirm they still meet eligibility requirements, although reassessment details have yet to be provided.)
After you’ve applied for coverage and received a confirmation of qualification from Service Canada, you’ll receive a welcome package from Sun Life (which is administering the plan on behalf of the government). It will include a membership card and explain when your coverage will start, along with details on how your dental-care bills will be paid. It’s important to note that CDCP coverage won’t begin until the date provided by Sun Life, so, if possible, don’t schedule any appointments until after that.
How will payments be made?
The way the plan is supposed to work is simple enough: your service provider, be it a dentist, denturist, or dental hygienist, will submit claims directly to Sun Life for reimbursement. In theory, you need do nothing more, un- less you have a copayment because your income was in the $70,000-to-$89,999 range. In such cases, you’ll have to remit the copayment directly to the service provider.
This is where some as-yet-unresolved issues arise. Enrolment as a CDCP service provider is voluntary, and while the government has expressed hopes that all providers nationwide will enrol, providers won’t be receiving details on exactly what will be required of them, and how much they’ll receive in reimbursement from Sun Life for the various covered treatments, until May.
Some providers have expressed concerns about red tape and procedural complications; others wonder about what the CDCP fee schedule will look like. As a result, and not- withstanding government expectations, there’s no guarantee that the provider(s) you’ve been using will take part, so you must be sure to ask if they’ve enrolled in the plan.
Furthermore, some dental-healthcare providers may not be entirely accepting of the CDCP reimbursement schedule (while they are “encouraged” to follow the CDCP fees, these differ from provincial and territorial fee guidelines), so you may need to pay some or perhaps even all of the cost of a particular procedure. (This would be separate from the co-payments mentioned above.) Accordingly, you also need to ascertain with your provider(s) exactly what costs will be covered by the plan and how much you may be expected to pay for any given treatment.
What’s covered?
In general, subject to the recommendation of an oral-health- care provider, the CDCP will help cover the cost of most oral- health-care services that keep your teeth and gums healthy and treat potential problems. Examples include:
- • preventive services, including scaling (cleaning), polishing, sealants, and fluoride.
- diagnostic services, including examinations and X-rays.
- restorative services, including fillings.
- endodontic services, including root-canal treatments.
- prosthodontic services, including complete and partial removable dentures
- periodontal services, including deep scalin.
- oral-surgery services, including extractions.
Some of these services won’t become available until the fall of this year—updates will be posted on the government website as more details become available. Some services, notably cosmetic work such as teeth whitening, will not be covered.
The bottom line is that it remained to be seen at press time— and may still remain to be seen as you read this—how all of the above unknowns will be resolved. As a result, in addition to applying and ensuring that you are approved for CDCP coverage, you should contact your oral-health-care provider(s) to ascertain, first, whether they are participating in the plan and, second, whether they fully accept the CDCP rate schedule or whether you might need to pay something (on top of whatever copayment might apply due to your income level). And you should do so as early as possible so that if you need to find a lower-cost alternative, you have the time to do so.
