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Canadian Dental Care Plan
By Neeru Panjwani, Director of Human Resources
This article provides information regarding the Canadian Dental Care Plan. We hope that this information will help you and your family use these benefits. Please be advised that ASP does not have any influence on how you use the program benefits and this is information is for awareness purposes.
The Canadian Dental Care Plan (CDCP) is a Federal government program that provides dental coverage for Canadian residents who do not have dental insurance and have a household income of less than $90,000 per year. The plan aims to reduce financial barriers to oral healthcare by offering a subsidy for various dental procedures, with eligible individuals being responsible for a co-payment based on their income level. The CDCP is administered by Sun Life on behalf of the government.
Know Before You Go
Depending on your family’s income, you may need to pay a percentage of the cost. The federal government will only pay a portion of the CDCP fees and you will be responsible for additional charges known as co-payments. This means that for many patients, treatments covered by the CDCP will not be free and only part of the cost of the procedure will be covered. You will have to pay these amounts directly to your dentist, if:
- your adjusted family net income is between $70,000 and $89,999; and
- you agree to dental care that the CDCP does not cover
Below is the co-payment breakdown based on adjusted family income.
| Adjusted Family Net Income | How much will the CDCP cover | How much you will 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% of 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% of the CDCP established fees. |
In addition to the co-payment requirements listed above, many of the established fees covered by the Federal government do not meet the full cost of the dental treatment. The difference will be your responsibility.
Preauthorization required for certain services
Starting November 1, 2024, a wider range of essential treatments, including partial dentures, crowns, and higher levels of sedation became available to CDCP patients through the launch of preauthorization. This expansion offers patients access to more care options.
The preauthorization process means that, while dentists recommend the best treatment based on their expertise, certain procedures need to be approved in advance for them to be covered under the CDCP.
The final decision to provide coverage rests with Sunlife and/or Health Canada. For patients, this process may require an additional waiting period. It’s advisable to discuss potential treatment options with your dentist in advance.
Applying and the CDCP welcome package
Appy online at: https://www.canada.ca/en/services/ benefits/dental/dental-care-plan/apply.html Your CDCP welcome packages may take up to three months to arrive from the time you apply. Your coverage start date will be included in the welcome package and may vary based on when you apply and when your application is processed. This means that you cannot receive care under the program until you have received your CDCP card and the official start date. Appointments can only be scheduled on or after your coverage start date.
Not everyone is eligible for the plan at the same time
The federal government is rolling out the CDCP coverage in stages. Health Canada is using a staggered approach to patients’ eligibility for care based on their registration date and age cohort.
Currently, the CDCP provides coverage for specific groups, including seniors aged 65 and over, children under 18, and adults with a valid federal Disability Tax Credit certificate. Full expansion is planned in 2025, with applications opening to remaining eligible Canadian residents.
Who Qualifies for CDCP
Individuals must meet all of the following criteria to be eligible for Canadian Dental Care Plan (CDCP) coverage.
- No access to a dental plan, meaning:
- no coverage through employer or a family member’s employer benefits; including health and wellness accounts;
- no coverage through pension (previous employer) or a family member’s pension benefits; or
- no coverage through a purchased plan by yourself or by a family member or through a group plan from an insurance or benefits company.
- an adjusted annual 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.
Patients who decide to opt out of benefits available to them from their employer, school, etc. will be considered by the federal government as someone who has access to dental plan. This means if you decline dental coverage through your/ your spouse’s employment benefits, you will not be eligible for the CDCP.
Is CDCP intended to replace existing insurance coverage
The Canadian Dental Care Plan (CDCP) is not intended to replace existing dental coverage. It is important that Canadians do not drop their existing coverage, as they might not be eligible for the CDCP if they do.
The CDCP is designed to provide coverage for Canadians who do not have an existing dental plan.
The Canada Revenue Agency now requires employers to report on their T4/T4A whether their employees and their families had access to dental plan coverage, including spending and wellness accounts.
Are Individuals with existing coverage through government programs eligible?
If you have dental coverage through a provincial, territorial, or federal government social program, you can still qualify for the Canadian Dental Care Plan (CDCP). If you meet all the eligibility criteria, your coverage will be coordinated between the plans to ensure there are no duplications or gaps in coverage.
Useful link for more details: www.canada.ca/en/services/benefits/dental/dental-care-plan.html
