The Canadian Dental Care Plan is an initiative spearheaded by the Canadian government to provide coverage for various dental procedures that help to ensure optimal dental hygiene as well as prevention of many oral diseases. A third of Canadians are not currently covered by dental insurance due to the fact that a lot of health insurance plans exclude dental services or limit coverage to annual cleanings. Many people are unaware of the importance of oral health where its neglect is linked to various life-threatening health problems including; respiratory diseases, diabetes, cancer, and mental health conditions, among many others. The Canadian Government is committed to offering a dental care plan that will ease the financial burden related to dental insurance for nine million uninsured Canadians. This guide’s purpose is to allow readers to assess their eligibility for the program and understand what exactly is covered, the benefits received, and an overview of the application process.
What is the Canadian Dental Care Plan?
One out of four Canadians avoided attending an oral health professional because they simply couldn’t afford it. The Canadian government acknowledges this as a significant problem in the health system contributing to various poor health outcomes, which is why the CDCP was formed. The Government of Canada has planned to invest $13 billion over the next five years in order to implement the CDCP and give access to dental coverage to millions of Canadians who were otherwise uninsured.
This plan is designed with those Canadians in mind who have a distrust of the healthcare system more generally. the CDCP is meant to be affordable and accessible, covering children under the age of 18 all the way up to seniors with disabilities. The CDCP is designed so that Canadian residents can become reintegrated into the health system and utilize basic oral health care services to avoid more fatal health outcomes in the future.
Who is Eligible for the Canadian Dental Care Plan?
An eligible applicant must be a Canadian resident, have a family net income of less than $90,000, and have filed their tax returns within the previous tax year. The plan is meant to be inclusive and includes children below the age of 18, low income adults, seniors of any age, as well as those with disabilities. These groups are broken down into subcategories who are asked to apply at different times throughout the year prioritizing the oldest patients first. Groups include seniors 87 and above, 77 to 86, seniors ages 72 to 76, seniors ages 70 to 71, seniors ages 65 to 69, persons with a disability tax credit certificate, children under 18 years of age, and any remaining potentially eligible Canadian residents.
This plan is intended to serve individuals with a variety of care needs including those with disabilities, and they may even qualify for additional services if needed if the individual is unable to conduct basic oral care practices on their own at home. If a Canadian resident is already receiving benefits from a Canadian province or by the federal government, they are still able to enroll in the CDCP if they meet all the other eligibility requirements. One is not eligible if they have an existing private insurance, do not meet the indicated income requirements, or are not Canadian residents.
What Does the Canadian Dental Care Plan Cover?
The CDCP covers a variety of dental services including routine check ups, cleanings, filings, and extractions. the CDCP believes that preventive care is essential in avoiding negative oral health outcomes down the line. These preventive services include cleanings, polishing, sealants, and fluoride. Preauthorization is not required for scaling and root planing but if there are any additional services they must be approved beforehand. If one wants to request that an additional service is covered they must offer detailed documentation to verify their eligibility.
Restorative services that need to be repeated or extended can be covered but require a written rationale of the service and its need. Restorations that include enamel and dentin fall under cosmetic and aesthetic services and therefore are not covered by the plan. Emergency services including oral surgery are generally covered by the plan with the exception of implants and ridge augmentation. Major surgical procedures including tooth exposure, fracture reduction, among others require preauthorization as well.
Services that are not covered or considered out of scope of the the CDCP plan include any cosmetic procedures, orthodontics, mouthguards, ridge augmentation, root re-sectioning, crown lengthening, extensive rehabilitation, among others that are not core oral health services. If one is unsure about a certain unit being covered, submit a pre authorization with the necessary documentation to confirm eligibility.
How to Apply for the Canadian Dental Care Plan
Canadian residents can initially apply for the CDCP through Service Canada, which is a government center. A letter will be mailed to eligible seniors that may qualify asking them to apply. It will include an application code and additional instructions for the application. Upon its completion, the applicant will wait for its approval. When an individual is officially approved, the applicant’s information is then shared with Sun Life so that they can be properly enrolled.
While completing the application you must provide a social insurance number, date of birth,full name, home address, any dental coverage through government social programs if applicable, and notice of assessment from one’s latest tax return. Make sure to submit one application per person that qualifies and note that the approval process can take up to three months.
How Much Does the Plan Cost?
The CDCP plan will cost something different depending on the adjusted annual family income. If your family makes under $70,000, there is no copayment. If family net income is between $70,000 and $79,999 there is a 40% co-payment, and if income is between $80,000 and $89,999 copayment will be 60%. The plan is designed so that patients will not face additional charges when establishing and receiving care, and these cost saving benefits are favorable to other private insurance options particularly for those experiencing financial difficulties. The only additional expenses that a patient will incur is if they opt for services that are exclusions like cosmetic procedures or certain orthodontic services.
How to Find a Dentist Under the Plan
In order to find participating dentists and oral care providers, the patient can search at Sun Life’s CDCP Provider Search or call the contact center at 1-888-888-8110. Make sure to confirm the following details before accepting care from an oral health care provider: confirm that the provider can accept CDCP clients, provide your coverage start date and copayment, and also inquire if there are any additional costs after you have paid your copayment.
It is essential that an appointment is scheduled as of the coverage start date or else the amount will not be covered, and the CDCP will not reimburse services before that indicated start date. Patients can book directly with the oral service care provider after Sun Life has enrolled the applicant and sent them a welcome package with coverage details, their member card, and the coverage start date.
Debunking Common Myths About the Canadian Dental Care Plan (CDCP)
There are a variety of myths related to the CDCP that must be clarified for potential applicants. One such myth includes that CDCP benefits are automatically accessible, but in reality eligibility depends on multiple factors. Again, one is eligible according to their income and age, and coverage begins once the applicant has been accepted by the necessary parties. Additionally, seniors are enrolled first, starting from the oldest applicants to the youngest.
Another myth is that the CDCP covers all dental expenses regardless of the service. the CDCP does cover most but not all dental expenses, and coverage is largely determined by income and previous patient treatment. Some patients may incur an additional copay so be careful to ask your provider to avoid unexpected charges. Please note that eligibility is confirmed annually so make sure you are confirming your eligibility each year.
Pros and Cons of the Canadian Dental Care Plan
There is no doubt that the CDCP is a benefit, cost saving plan that will help many uninsured Canadians to obtain access to dental care. These benefits include its accessibility, affordability, and one’s improved oral and overall general health. Potential cons of the dental plan could include wait times, coverage gaps, and the lack of regional availability.
Tips for Maximizing Your Benefits
In order to maximize your benefits from the plan one must get regular check ups as preventive care is an important tenet of avoiding longer term more serious health related problems. If one is being seen regularly, the provider can potentially catch something serious in its early stages so that it can be resolved quickly. Additionally, it is important to inquire about unexpected dental needs and emergencies under the plan to ensure that these additional services are covered by the CDCP so you do not incur additional costs that you have not budgeted for.
Future of the Canadian Dental Care Plan
As of June 2024, the Canadian government is continuing current coverage and expanding the CDCP program. The CDCP will provide $250 million over three years beginning in 2025 and after that $75 million in order to establish an Oral Health Access Fund. This fund will aim to reduce barriers for vulnerable populations including those in rural and remote communities to receive care. This fund will help to revolutionize Canadian dental care and the healthcare system in Canada more generally. Oftentimes those under resourced populations are the ones who suffer most and end up distrusting the medical system entirely, resulting in negative outcomes and significant gaps based on race, socio economic status, and residency.
Maximizing the Benefits of the Canadian Dental Care Plan
The Canadian Dental Care Plan is an important tenet of an overall Canadian approach to remedy the many existing gaps in the Canadian healthcare system. This guide provides a quick overview of the CDCP plan as well steps to determining eligibility, applying, and other frequently asked questions. It is important that Canadians take advantage of this plan if they are eligible as dental care is essential to one’s overall health. Stay up to date about the advancements regarding this plan and new potential initiatives by visiting government websites, consulting with various dental professionals, and staying informed and in contact with your current insurance.
