Dental care is an essential component of overall health, yet many Canadians struggle with receiving proper care because of the cost of dental treatments. This is where the Canada Dental Care Plan can make a difference.
Canada Dental Care Plan (CDCP) is one of the country’s largest social programs. This government initiative is designed to improve access to dental care for Canadian citizens who may not be able to afford it. This includes coverage of a wide range of dental procedures that can improve and maintain oral health.
As of writing, the CDCP has successfully approved a total of 2,494,877 applicants who may already use their plan benefits and has provided 751,048 applicants with dental care.
But what exactly does this plan cover, and how can you benefit from it?
This comprehensive guide will walk you through the key aspects of the Canada Dental Care Plan一 what it is and its objectives to its eligibility criteria, and how you can apply.
Introduction: What is the Canada Dental Care Plan (CDCP)?
Did you know that almost one in four Canadians avoid dental care due to cost? This is the main reason why the Canada Dental Care Plan (CDCP) was introduced. The main goal is to make essential and emergency dental care more accessible to lower-income families and individuals.
This initiative is a major step toward reducing dental-health related disparities, making sure all Canadians are able to receive accessible dental care. By removing these financial barriers through government-funded support, the plan seeks to improve oral health and, by extension, overall oral health for Canadians.
Canada Dental Care Plan: How It Differs from Other Programs
You might wonder how the Canada Dental Care Plan compares to existing local provincial dental programs or private insurance. Some key differences include:
- Broad, income-based eligibility – While many provincial programs are limited to specific age groups, the CDCP is focused on helping low- and middle-income individuals and families.
- Comprehensive coverage – The plan covers more than just basic dental care, extending to emergency and preventive treatments.
- No monthly premiums – Unlike private insurance, participants do not need to pay out-of-pocket monthly to maintain their coverage.
Eligibility Criteria for the Canada Dental Care Plan
To qualify for the Canada Dental Care Plan, you must meet certain eligibility criteria. Here’s a detailed breakdown:
- Age requirements – The plan is designed to cover Canadians of all ages, but children under 18 and seniors (65+) are prioritized.
- Income threshold – Individuals and families with an annual household income of less than $90,000 are eligible.
- Lack of alternative coverage – You must not have access to other comprehensive dental insurance plans. This includes employment benefits (whether as an individual or member of the family), other health and wellness accounts, from professional or student organizations, pension benefits (unless retired and opted out of pension), and individual or group coverage from insurance or benefits companies.
- Updated tax returns – You and your spouse/common-law-partner must have filed your tax returns for assessment
- Residency – You must be a Canadian resident for tax purposes
To find out if you qualify, you can use the online eligibility checker provided on the government’s Canada Dental Care Plan website. It should provide a checklist and upon confirmation, it will redirect you to your designated application schedule according to your age.
How to Apply for the Canada Dental Care Plan
Applying for the Canada Dental Care Plan is straightforward. Here’s a step-by-step guide:
- Invite letter and eligibility – An invite letter will be sent in phases by age group. As of November 2024, the following should have already received their invite for application:
- Seniors 65 and above
- Adults aged 18-64 with a valid Disability Tax Credit certificate*, and
- Children under 18 years old
All remaining eligible Canadian residents will receive their invites starting 2025.
*The Disability Tax Certificate certifies that the holder has a severe or prolonged impairment or significant limitations on specific medical categories, or receive therapy to support vital function.
- Gather required documents – When you apply, the following information must be provided:
- Social Insurance Number (SIN, if available for children)
- Date of birth
- Full name
- Home and mailing address
- List of dental coverage through government social programs (if applicable)
- Notice of Assessment after tax return filing
You must submit one application for everyone in the family who qualifies to prevent delays.
- Submit application
There are several routes in which you can submit your application and document requirements:
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- Online application – This is the best and easiest way to apply. An application link is available in the official Canada Dental Care Plan (CDCP) government website. Simply click the link, fill out the form completely and accurately, and attach the corresponding documents.
- Through call – You may apply by phone via 1-833-537-4342 and select option 1 to complete your application. Enter your application code found on the top right corner of your invitation letter, then your SIN, and input the details as required.
- In-person application – For those without internet and phone access, some government offices and community centers accept paper applications and in-person submission.
- Teletypewriter service (TTY) – For the hearing impaired, TTY is available 1-833-677-6262.
You may apply for yourself and your children, and on behalf of someone else provided that you are a legal delegate or Power of Attorney.
- Wait for approval – You should receive your approval information after a few weeks. A letter will be sent to your mailing address regarding the decision.
To check your status, you may check the status checker tool available online. Simply input your application code or client number and SIN. You may also call 1-833-537-4342 and select option 2. Representatives are available 8:30am – 4:30pm local time, except on statutory holidays.
- Receive your coverage details – Once the application is confirmed, your coverage will begin on the date provided in your welcome package from Sun Life, the official partner of CDCP. This should arrive within 3 months after you apply.
Note that the CDCP will not reimburse you for dental services received before that date.
Services Covered Under the Canada Dental Care Plan
One of the plan’s biggest advantages is the wide range of services it covers. Here’s a comprehensive list of what is included:
- Diagnostic and Preventive Services – to prevent dental disease and maintain your oral health status:
- Dental exams
- X-rays
- Cleaning
- Fluoride applications
- Sealants
- Restorative Services – to treat cavities and broken teeth
- Permanent and temporary fillings
- Pain control for diseased teeth
- Crowns and crown repair
- Posts, cores, post removal
- Endodontic Services – to treat severely decayed, infected, or broken teeth
- Root canal treatment
- Pulpectomy
- Procedures to reduce infection and relieve pain
- Re-treatment of previously completed root canal therapy
- Periodontal Services – to treat the gums and bone surrounding the teeth
- Root scaling and planing
- Treating abscesses
- Non-surgical gum disease management
- Prosthodontic Services – to replace missing teeth and related tooth replacement services
- Complete and partial Dentures (standard and temporary)
- Denture repair, reline, rebase
- Placement of liner on oral tissues
- Overdentures
- Oral Surgery Services – to remove teeth and tumours and fix other complex problems of the mouth and jaw
- Tooth extraction
- Surgical removal of tumours and cysts
- Surgical incision and drainage
- Treatment of broken jawbones
- Anaesthesia and Sedation Services – to control pain while another service is being performed
- Conscious sedation
- Moderate to deep sedation
- General anaesthesia
Orthodontic services are currently not covered by the CDCP. But, should be made available by 2025 with a maximum spending limit applicable.
Understanding Your Coverage and Benefits
Some key terms that are important in your coverage are the following:
Co-payments
Under the CDCP, some individuals that fall under a certain adjusted family net income bracket are required to have a co-payment. This is the percentage of CDCP fees that is not covered, so you will have to pay directly to the oral health provider.
Based on your adjusted family net income, here is your corresponding co-payment:
| Adjusted family net income | How much will the CDCP cover | How much will you cover |
|---|---|---|
| Lower than $70,000 | 100% of eligible oral health care service costs will be covered at the CDCP established fees | 0% of the CDCP established fees |
| Between $70,000 and $79,999 | 60% of eligible oral health care service costs will be covered at the CDCP established fees | 40% co-payment under the CDCP established fees |
| Between $80,000 and $89,999 | 40% of eligible oral health care service costs will be covered at the CDCP established fees | 60% co-payment under the CDCP established fees |
About Additional Charges
You may still face additional charges in addition to the rules of co-payment if:
- The cost of your oral health services are more than what the established CDCP fees are
- You agree to receive dental care that the plan does not cover
It is important that you discuss with your oral health care provider about any costs that will not be covered by the plan. This will help you prepare to cover out-of-pocket expenses, if necessary.
How to Compute for Co-payment and Additionals
If you are still confused of the cost of your dental treatment under the CDCP, considering co-payment and additional charges, here’s an example:
- An individual under 40% co-payment
- 2 units of scaling: CDCP fee: $134; oral health practitioner’s fee: $145
In this scenario, the patient is required to pay the difference of $11 and the 40% co-payment which is $53.60. So, they will pay the provider $64.60 and the CDCP will pay the provider $80.40 (60% of the CDCP established fees).
Preauthorization Request
Preauthorization is a process to request coverage for services prior to proceeding with treatment. Certain dental services, though covered by the CDCP, require preauthorization so both the patient and oral health provider can understand if the treatment is covered and the limitations to it, if applicable.
Preauthorization is required for:
- Retreatment of previously completed root canal
- Bonding for mobile teeth
- Post-surgical evaluations
- Crowns, posts, and cores
- Complete immediate and overdentures
- Partial dentures
- Moderate and deep sedation
- General anaesthesia
The request for preauthorization will be submitted by the oral health provider along with the supporting requirements. Preauthorization decisions, depending on the nature of service, are valid for up to 24 months from the date of approval. Provided that the client is still eligible or covered by the CDCP on the date of service.
Frequency Limitations
This refers to the restrictions on how often certain dental services can be covered by the CDCP within a specific time period. This takes into account all the treatments that are under the CDCP.
To know more, you may access this link for comprehensive information on the services that are covered by the CDCP, which services require preauthorization, those out of coverage at any time, and the corresponding frequency limitation of specific treatments.
Tips to Ensure a Smooth Application Process
To avoid common pitfalls and denied applications, here are a few tips for you:
- Double-check your information – Ensure that all details are accurate and complete before submission.
- Gather all necessary documentation – Missing paperwork is one of the most common reasons for delays.
- Submit online if possible – Digital submissions are processed more quickly.
- Do not resend applications – Wait for your plan decision patiently and avoid resending applications. You may check the online status checker tool for updates.
How to Find a Participating Dentist or Clinic
Sierra Dental is proud to be a participating clinic in the Canada Dental Care Plan. If you are within our area and would like to maximize your coverage plan, simply schedule an appointment with us and we will go over your benefits, discuss your options, and help you with your treatment.
If you are looking for other participating oral health provider, here’s how you can find them:
- Online directory – A list of the CDCP oral health providers is available through the Sun Life website. You may access it here.
- Contact Sun Life – You may also directly call the Sunlife CDCP Contact Centre at 1-888-888-8110 for information.
- Referrals – Your general practitioner, another healthcare professional, or someone you know may also provide information on participating clinics.
Frequently Asked Questions
What should I do if a service is not covered?
If a service is not covered, consult with your dentist to explore alternative treatments that fall within your coverage. Otherwise, you can inquire about payment plans, but the expenses will be entirely out of your pocket.
What should I do if my claim is denied?
If your claim is denied, you can appeal the decision by providing additional information or any documentation.
Can you reapply?
If you are already enrolled in the CDCP, you do not need to reapply unless your access to dental insurance has changed.
How often should you renew your eligibility in the CDCP?
The CDCP does not necessarily require annual renewal for eligibility, but it is essential to periodically review and update your information to ensure you continue to meet the program’s requirements. Always verify with the program to avoid disruptions in your coverage.
Conclusion
The Canada Dental Care Plan offers significant benefits for those struggling to afford dental care. By covering a wide range of services, making dental treatments accessible, and offering these to a wide age demographic, this plan has the potential to greatly improve the oral health of Canadians now and into the future.
If you are eligible, take advantage of this opportunity to get the dental care you need. Contact Sierra Dental today to find out how you can benefit from the Canada Dental Care Plan. You may also access this link to be redirected to the government website that should provide further information on the Canada Dental Care Plan and the contact details that may help you with your inquiries.