What you need to know about the Canadian Dental Care Plan
Oral health is crucial for overall well-being, yet many Canadians face financial barriers to dental care. One in four Canadians avoided dental visits due to costs in 2022. Poor oral health not only impacts physical health but can also lead to mental health issues and social challenges.
To address this, the Government of Canada introduced the Canadian Dental Care Plan (CDCP). With a $13 billion investment over five years, the CDCP aims to provide affordable oral health care for up to nine million uninsured eligible Canadian residents, earning less than $90,000 annually.
As a trusted partner in the healthcare insurance industry, we want to ensure that you have all the necessary information to assist your clients in navigating this new program effectively.
Who is eligible?
Eligibility for the CDCP is based on several factors, including:
- No access to dental insurance
- An adjusted family net income of less than $90,000
- Be a Canadian resident for tax purposes; and
- Have filed their tax return in the previous year
Canadian residents who have access to dental benefits through a social program offered by their province or territory and/or by the federal government will be eligible for the CDCP if they meet all the eligibility criteria.
Children under 18 will be considered eligible based on their parent or guardian’s income eligibility.
Note: eligibility will be reassessed annually.
For a parent or guardian of a child under the age of 12, that does not have access to dental insurance, they may already be eligible for the Canada Dental Benefit. This benefit is available until June 30, 2024.
Phased rollout
To facilitate a smooth implementation, the government has decided to roll out the CDCP in phases. The program has first been made available to seniors.
Application schedule for eligible Canadian residents:
- December 2023: Ages 87 and older
- January 2024: Ages 77 – 86
- February 2024: Ages 72 – 76
- March 2024: Ages 70 – 71
- May 2024: Ages 65 – 69
Canadians with a valid Disability Tax Credit certificate, as well as children under the age of 18, can apply as of June 2024. All remaining eligible Canadians will be able to apply starting in 2025.
What will be covered?
The CDCP will cover a wide range of oral health services, including preventive procedures like cleanings, polishing and fluoride treatments, as well as diagnostic services such as exams and X-rays. Additionally, more complex procedures like cavity fillings, dentures and root canals will be included.
Some oral health care services such as crowns, initial placement of partial dentures and general anesthesia will require preauthorization, prior evaluation from an oral health provider, which will be available beginning in the fall of 2024.
Each service covered by the plan will be compensated at the 2024 CDCP fees, which may differ from provincial and territorial suggested fee guides. The CDCP will reimburse a percentage of the cost based on these established CDCP fees.
It’s essential to note that not all applicants will be eligible for 100 per cent coverage. The CDCP will reimburse a percentage of eligible expenses based on applicants’ income levels, with the remainder being a copayment. For example:
- Canadians with an adjusted annual family net income of less than $70,000 will have no copayment;
- Canadians with an adjusted annual family net income between $70,000 and $79,999 will have a 40 per cent copayment; and
- Canadians with an adjusted annual family net income between $80,000 and $89,999 will have a 60 per cent copayment.
The program aims to streamline the billing process by allowing oral health providers to directly bill the federal plan, reducing the need for patients to pay out-of-pocket. Oral health providers participating in the CDCP will bill Sun Life, the insurer handling the program, directly for the eligible services provided to ensure timely reimbursement.
Individuals covered under the program may still incur out-of-pocket expenses. This could include co-payments or additional charges, which will be paid directly to their oral health provider.
When will coverage start?
Coverage under the CDCP will commence once eligibility has been confirmed and applicants have been enrolled in the program. Seniors will be able to access oral health providers as early as May 2024.
Upon confirmation of eligibility, applicants will receive a welcome package from Sun Life, the insurer handling the program, detailing their coverage start date and plan specifics.
It’s crucial to remind clients that appointments with oral health providers should be scheduled on or after the specified coverage start date provided in the welcome package. The CDCP will not reimburse for services received before the start date.
Canadian will have to ask their oral health-care provider if they have enrolled in the federal plan, as there are also requirements for dentists and hygienists to opt in. Oral health providers can confirm their participation in the CDCP starting March 11, 2024.
The introduction of the Canadian Dental Care Plan represents a significant step forward in improving access to dental services for Canadians. As a licensed insurance advisor, your role in guiding clients through this transition is vital. We encourage you to stay informed and assist your clients in understanding their eligibility, coverage options, and enrollment process under the CDCP.
If you have any questions or require further assistance, please don’t hesitate to reach out to a Saskatchewan Blue Cross Account Executive.