CDCP

What is the Canadian Dental Care Plan?

The Canadian Dental Care Plan (CDCP) is an initiative launched by the Government of Canada with the aim of making dental care more accessible and affordable. This program is designed to help individuals who may not have the financial means to afford necessary dental treatments, thereby ensuring they can maintain good oral health. The plan reflects the government’s commitment to improving the overall health and well-being of Canadians by addressing a critical component of healthcare that often gets overlooked.

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How Does the Canadian Dental Care Plan Work?

Set to commence in May 2024, the CDCP will provide publicly funded dental benefits to eligible individuals. To qualify for this plan, applicants must have an annual household income of less than $90,000 and must not have private dental insurance. The CDCP aims to cover the full or partial costs of a range of oral health treatments. These treatments are not only intended to prevent and manage oral diseases but also to help protect against more severe health issues that can arise from poor oral health.

The scope of the plan includes various dental services such as check-ups, cleanings, fillings, x-rays, and other necessary treatments. By alleviating the financial burden of dental care, the CDCP seeks to ensure that more Canadians can access the dental services they need, ultimately leading to better overall health outcomes.

How Can I Apply for the CDCP?

The application process for the CDCP will be rolled out in phases between December 2023 and 2025. Beginning in May 2024, seniors aged 65 and older will be able to apply for the plan either online or over the phone. This phased approach is designed to manage the enrollment process efficiently and ensure that those who need the benefits most can access them promptly.

For detailed information on how to apply, including specific dates and requirements, prospective applicants are encouraged to consult the FAQs and other resources provided by the government. These resources will offer step-by-step guidance on the application process, helping ensure that eligible individuals can take full advantage of the benefits offered by the CDCP.

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Frequently Asked Questions

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.

Eligible Age Groups Date Applications Open
Seniors 87+ December 2023
Seniors between 77 – 86 January 2024
Seniors between 70 – 71 March 2024
Seniors between 65 – 69 May 2024
People holding a valid Disability Tax Credit Certificate June 2024
Children under 18 June 2024
All other eligible Canadian citizens and residents 2025

 

How much will the CDCP cover?

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.

Net Family Income Covered by CDCP Covered by Patient
Below $70,000 100% 0%
$70,000 – $79,999 60% 40%
$80,000 – $89,999 40% 60%

 

 

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

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.

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.

How will I receive confirmation of my CDCP enrollment?

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.

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

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)