Dental costs and the Canadian Dental Care Plan: who qualifies and what it pays

The Canadian Dental Care Plan (CDCP) helps make dental care more affordable for eligible Canadian residents [1]. This plan covers a portion of the cost for many oral health services [3]. Understanding who qualifies and what the plan covers can help you manage your dental care costs.

Who Qualifies for the Canadian Dental Care Plan

To apply for the CDCP, you must meet four specific requirements [2]. These requirements help determine if you are eligible for the plan.

Requirement 1: No Access to Private Dental Insurance or Coverage

You cannot have access to private dental insurance or coverage, including health spending accounts that cover dental costs [2]. This means you are generally excluded if you have coverage through any of the following [2]: * Your work or pension plan [2]. * A family member's work or pension plan [2]. * A professional or student organization [2]. * Insurance or coverage you or a family member purchased for dental costs, including any enhancements or top-up insurance [2].

You are not eligible even if you have never used your dental insurance, decided not to enrol in it, have to pay a premium for it, or if it does not cover the full cost of your dental care [2].

There is one exception: if you are retired and opted out of your dental insurance or coverage through your pension plan before December 11, 2023, and cannot opt back in, you may still be eligible [2]. However, if you opted out after December 11, 2023, you are not eligible, regardless of whether you can opt back in [2].

How to Check Your Tax Slip for Dental Coverage Information

Before you confirm that you do not have access to dental insurance or coverage, you can check your tax slips [2]. * If you work, look at box 45 on your T4 tax slip(s) [2]. * If you receive a pension, look at box 015 on your T4A tax slip(s) [2].

Here’s what the numbers in these boxes mean [2]: * If you see the number 1, it means you do not have access to dental insurance or coverage through your work or pension plan [2]. * If you see the number 2, 3, 4, or 5, it means your work or pension plan offers some kind of dental insurance or coverage for you and your family [2].

It is important to also check the T4 or T4A slips of your spouse or common-law partner, if applicable [2]. You or your dependants might have access to dental insurance through their work or pension plan [2]. If you apply and your tax slip shows you had access, you may need to provide proof that you no longer have it [2]. If this proof shows you still have access, you could be removed from the plan and may need to reimburse the government for services paid while you were ineligible [2].

Requirement 2: File Your Tax Return in Canada

You and your spouse or common-law partner, if applicable, must have filed your tax returns in Canada for the previous year [2]. This allows the government to assess your family income [2].

Requirement 3: Your Adjusted Family Net Income Is Less Than $90,000

Your adjusted family net income must be less than $90,000 to be eligible for the CDCP [2].

To calculate your adjusted family net income, use the following equation from your tax return and your spouse or common-law partner's tax return (if applicable) [2]: * Your family net income (line 23600) [2] * Minus any universal child care benefit (UCCB) and registered disability savings plan (RDSP) income received (line 11700 and line 12500) [2] * Plus any UCCB and RDSP amounts repaid (line 21300 and line 23200) [2] * Equals your adjusted family net income [2]

Requirement 4: You Are a Canadian Resident

You and your spouse or common-law partner, if applicable, must be a Canadian resident for tax purposes [2].

Government Social Programs and Eligibility Review

If you have dental insurance or coverage through a provincial, territorial, or federal government social program, you might still qualify for the CDCP [2]. In such cases, the plans may coordinate coverage to avoid duplication [2].

To remain eligible for the CDCP, you must confirm each year that you do not have access to private dental insurance or coverage [2]. Providing false information can lead to removal from the plan and a requirement to reimburse the Government of Canada for services paid [2].

What Services Are Covered by the CDCP

The CDCP helps pay a portion of the cost for a wide range of oral health care services [3]. Some services are covered without preauthorization, while others require it [3]. Preauthorization means your oral health provider will recommend services, and the CDCP will confirm coverage before you receive them [3]. The decision considers your oral health history and medical conditions, and not all requests are approved [3].

Examples of services that could be covered when recommended by an oral health provider include [3]:

Diagnostic and Preventive Services

These services check your oral health, help keep your mouth healthy, prevent cavities and gum disease, and detect conditions like cancer early [3]. * Dental exams, including complete, routine, specific, and emergency exams [3]. * X-rays [3]. * Cleaning (scaling) [3]. * Fluoride applications [3]. * Sealants [3].

Basic Services

These services address common dental issues.

Restorative services

These services treat cavities and broken teeth [3]. * Permanent fillings [3]. * Temporary fillings [3]. * Pain control for diseased teeth [3]. * Other treatments for cavities [3].

Endodontic services

These services treat severely decayed, infected, or broken teeth [3]. * Root canal treatments [3]. * Pulpectomies (the first step of a root canal treatment) [3]. * Procedures to reduce infection and relieve pain [3]. * Re-treatments of previously completed root canal treatments (require preauthorization) [3].

Periodontal services

These services treat the areas around your teeth, including gums and bone [3]. * Cleaning under the gumline [3]. * Treating abscesses [3]. * Bonding for mobile teeth (requires preauthorization) [3]. * Post-surgical evaluations (require preauthorization) [3]. * Non-surgical gum disease management [3].

Major Services

These services address more complex dental needs.

Restorative services

These services restore teeth that are too damaged for basic fillings [3]. * Posts and post removal [3]. * Repairs to crowns and re-bonding of crowns and posts [3]. * Crowns (require preauthorization) [3]. * Cores (to support crowns) (require preauthorization) [3]. * Posts for crowns (require preauthorization) [3].

Removable prosthodontic services

These services replace missing teeth [3]. * Complete dentures, including standard and temporary dentures [3]. * Denture repairs, relines, and rebases [3]. * Placing lining in dentures to condition oral tissues (for comfort and healing) [3]. * Complete immediate and overdentures (require preauthorization) [3]. * Partial dentures (require preauthorization) [3].

Oral surgery

These services involve removing teeth or tumours and fixing other problems in the mouth and jaw that need surgery [3]. * Removal of teeth and roots [3]. * Surgical removal of tumours and cysts [3]. * Surgical incisions, including draining [3]. * Treatments for broken jaw bones [3].

Anesthesia or sedation services

These services provide sedation and pain management during dental procedures [3]. * Nitrous oxide, oral sedation, or both together [3]. * Conscious sedation – inhalation or combined technique (requires preauthorization) [3]. * Deep sedation or general anesthesia (require preauthorization) [3].

Orthodontic Services

Orthodontic services are not yet available under the CDCP [3]. A specific range of orthodontic services will be available in the future, at a date to be determined, and will require preauthorization [3].

How Much the CDCP Will Cover

The CDCP will reimburse a portion of your treatment cost, but it may not pay the full amount [3]. You might need to pay additional charges directly to your oral health provider [3].

Co-payments Based on Adjusted Family Net Income

A co-payment is the percentage of the CDCP fees that the plan does not cover [3]. You will pay this amount directly to your oral health provider [3]. Your co-payment depends on your adjusted family net income [3]:

• Adjusted family net income lower than $70,000: The CDCP will cover 100% of eligible oral health care service costs at the CDCP established fees [3]. Your co-payment will be 0% of these fees [3].
• Adjusted family net income between $70,000 and $79,999: The CDCP will cover 60% of eligible oral health care service costs at the CDCP established fees [3]. Your co-payment will be 40% of these fees [3].
• Adjusted family net income between $80,000 and $89,999: The CDCP will cover 40% of eligible oral health care service costs at the CDCP established fees [3]. Your co-payment will be 60% of these fees [3].

Understanding Additional Charges Beyond Co-payments

It is important to know that the CDCP fees may not be the same as what oral health providers charge [3]. This means you might have to pay fees in addition to any potential co-payment [3]. This can happen if [3]: * The cost of your oral health care services is more than what the CDCP will reimburse for those services [3]. * You and your oral health provider agree to services that the CDCP does not cover [3].

Before you receive any oral health care, you should always ask your provider about any costs that the plan will not cover [3]. Make sure you understand what you will have to pay directly to your provider before agreeing to treatment [3]. If you are covered by the CDCP, you should not pay the full cost upfront, but you may still need to pay any additional charges directly to the provider [3].

What this means for you

The Canadian Dental Care Plan can help make dental care more accessible and affordable for many Canadians. However, it is essential to understand the details of the plan to manage your expectations and costs.

First, carefully review the eligibility requirements, including checking your tax slips, to confirm you qualify [2]. If your income is between $70,000 and $89,999, be prepared for a co-payment [3]. More importantly, remember that the CDCP's established fees might be different from what your dental provider charges [3]. This means you could have additional out-of-pocket costs even if a service is covered by the plan [3]. Always discuss potential costs with your dental provider before starting any treatment [3].

If you are looking for a dental provider, you can use resources like Clinic Directory to find dentists in Calgary or dentists in Toronto, or in other locations across Canada. When choosing a dentist, it can be helpful to consider factors like location, services offered, and how they handle billing for plans like the CDCP. You can learn more about how to choose a dentist in Canada.

Dental professionals in Canada are regulated by provincial bodies. If you have questions about a dentist's registration or professional standards, you can contact the appropriate regulatory body for your province. For example, dentists in Alberta are regulated by the College of Dental Surgeons of Alberta [4]. In British Columbia, the BC College of Oral Health Professionals oversees dental professionals [5]. In Ontario, the Royal College of Dental Surgeons of Ontario regulates dentists [6]. A licensed dental professional can assess your specific oral health needs and discuss treatment options and associated costs.

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