CDCP

Canadian Dental Care Plan (CDCP)



What is the Canadian Dental Care Plan (CDCP)?

 

The Canadian Dental Care Plan (CDCP) is a federal program that aims to improve access to oral health care for Canadians who do not have dental insurance and have an adjusted household income below $90,000. The program will cover some of the costs of various dental services, such as exams, cleanings, fillings, extractions, and root canals.

Eligible Canadians will receive a letter from Service Canada with a personalized application code and instructions on how to apply online, by phone, or in person. Once approved, they will receive a CDCP card that they can present to participating oral health care providers to receive the covered services.

As your family dentist, we have a responsibility to perform the best dentistry possible for you and your family and we are hoping the program will allow us to maintain our standard of care.



What is covered by the CDCP?

 

The CDCP helps cover a wide range of oral health care services, such as:

 

  • preventive services, such as scaling (cleaning), polishing, sealants, and fluoride
  • diagnostic services, such as examinations and x-rays
  • restorative services, such as fillings
  • endodontic services, such as root canal treatments
  • prosthodontic services, such as complete dentures and partial removable dentures
  • periodontal services, such as deep scaling
  • oral surgery services, such as extractions

 

MOST oral health care services will require preauthorization (that is, prior approval is required from the CDCP before the treatment is provided) to confirm that it will be covered under the plan.

Preauthorization services will be available starting in November 2024.



What is not covered by the CDCP?

 

The CDCP does not cover any dental procedures related to non-eligible dental services, and it does not cover dental procedures related to a dental service reviewed by the CDCP where criteria and policies are not met. Some examples are:

 

  • cosmetic dentistry, such as veneers and whitening
  • temporomandibular joint (TMJ) therapy
  • sports mouth guards and night guards
  • snoring and sleep apnea appliances


What are the eligibility criteria for the CDCP?

 

To qualify for the CDCP, one must:

  • not have access to dental insurance
  • have an adjusted family net income of less than $90,000
  • be a Canadian resident for tax purposes
  • have filed their tax return in the previous year

 

Not having access to dental insurance is defined as:

  • No dental insurance through your employer or a family member's employer benefits, including health and wellness accounts
  • No dental insurance through your pension (previous employer) or a family member's pension benefits
  • No coverage through a professional or student organization
  • No dental insurance purchased by yourself or by a family member through a group plan from an insurance/benefits company.

 

NOTE: Any Canadian resident is still considered to have access to dental insurance if they choose to opt out of existing benefits, like those listed above.

  

The federal government has committed to rolling out the CDCP coverage in stages. Starting in mid-December 2023, letters were mailed to seniors aged 87 and above who may qualify, followed by those aged 77 to 86 in January 2024, then those aged 72 to 76 in February 2024 and those aged 70 to 71 in March 2024. These letters include a personalized application code and instructions on how to apply. Seniors aged 65 to 69 may apply in May 2024. Children under 18 may apply starting in June 2024, and all remaining eligible Canadian residents can apply starting in 2025.

 

The CDCP and details continue to evolve, we will try our best to keep this information as current as possible.

For more detailed, up-to-date information, visit: https://www.canada.ca/en/services/benefits/dental/dental-care-plan/visit-provider.html



What are the co-payments for the CDCP?

 

You may have a co-payment based on your adjusted family net income. A co-payment is the percentage of the CDCP fees that is not covered by the CDCP, and that you will have to pay directly to the oral health provider. Your co-payment is based on your adjusted family net income as follows:

  • if your adjusted family net income is lower than $70,000, the CDCP will cover 100% of the eligible oral health care service costs at the CDCP established fees, and you will not have a co-payment

  • if your adjusted family net income is between $70,000 and $79,999, the CDCP will cover 60% of the eligible oral health care service costs at the CDCP established fees, and you will have a co-payment of 40%

  • if your adjusted family net income is between $80,000 and $89,999, the CDCP will cover 40% of the eligible oral health care service costs at the CDCP established fees, and you will have a co-payment of 60%

It is important to note that 100% of the CDCP fee does not equal 100% of the provincial/territorial dental association fee guide, as Health Canada decided not to cover the full costs of treatment through CDCP, and dentists may have to balance-bill the part of the dentist's standard fee not covered by the CDCP, in order to continue to operate and maintain the level of care expected of our dental profession.

 

You may therefore have to pay additional charges directly to the oral health provider:

  • for the difference between the lower CDCP fee and the standard provincial/territorial dental association service fee, or
  • for services you and your oral health care provider agree to that the CDCP does not cover.

 

What if I have coverage under Ontario's Dental Programs (Healthy Smiles Ontario, ODSP, OSDCP, OW)?

  

  • The CDCP will be the primary payer relative to all of the Ontario dental programs
  • Where coordination is possible, Ontario's programs - the Healthy Smiles Ontario Program and the Ontario Disability Support Program (ODSP) - will serve as the secondary payer.

 

CDCP clients will continue to be responsible for paying, directly to the provider, any applicable amounts or services not covered by the CDCP and/or Ontario dental programs.

For oral care services requiring preauthorization:

  • CDCP will start accepting requests for pre-authorizations in November 2024. There is no coverage under CDCP for services requiring preauthorization prior to November 2024 and there will be no coordination of benefits.
  • Prior to November 2024, where services covered by Ontario's dental programs require preauthorization, Ontario's programs will need to be contacted directly.

  



Sources:

  1. Health Canada at Canada.ca/dental
  2. Ontario Dental Care Plan (CDCP) 2024 Dental Benefit Grid
  3. Ontario Dental Association (ODA) oda.ca/cdcp, member resources