The Canadian Dental Care Plan (CDCP) is the government’s plan to make dental care accessible and affordable.
But are you covered by it? Can you be? What does it cover? Here are some ‘secrets’ about the CDCP you really need to know.
1. You probably will still need to pay out-of-pocket for dental care
Even if you qualify for the CDCP, you may still have to pay for a portion of your dental work. Our government-run plan has strict income-based eligibility requirements, a limited fee schedule that often differs from what dentists charge and does not cover cosmetic or complex procedures.
- Co-payments based on income: For eligible individuals with an adjusted family net income between $70,000 and $89,999, co-payments of 40% to 60% are required. Those with an income under $70,000 generally have no co-payment for covered services.
- Fees differ from dentists’ rates: The fees reimbursed by the CDCP may be lower than the standard provincial rates that many dental providers charge. Dentists are not mandated to follow the CDCP fee guide, and if they charge more, you are responsible for paying the difference directly to them.
2. You might not be eligible even if you want to have CDCP coverage
The CDCP is not a universal benefit and is intended for Canadians who lack access to any dental coverage.
- Cannot have other insurance: If you have any form of dental coverage through an employer, school, or a private plan—including a health or wellness spending account—you are ineligible for the CDCP. This remains true even if you choose not to use the coverage.
- No opting out: You cannot drop existing private coverage to become eligible for the CDCP. The Canada Revenue Agency now requires employers to report on T4 slips whether employees have access to dental insurance.
3. It might not cover the procedure you need
The plan focuses on essential, preventative, and restorative procedures, and many services are explicitly excluded or limited.
- Exclusions: Treatments generally not covered include cosmetic dentistry (whitening, veneers), most orthodontics, dental implants, night guards, sports guards, and TMJ therapy.
- Pre-authorization and frequency limits: Some advanced procedures like crowns and dentures require pre-authorization from the plan administrator (Sun Life) before treatment. There are also frequency limits on many services, such as how often you can get a cleaning or exam.
4. You might need to change your dentist to use CDCP
You can only get treatment under the CDCP from providers who have registered for the program.
- No guarantee of participation: While most dental providers have signed up for the CDCP, some have chosen not to due to low reimbursement rates and administrative issues. It is your responsibility to confirm that your dentist accepts the CDCP before your appointment.
- Claim-by-claim basis: In some cases, a dentist who is not registered may agree to submit a claim for you, but there is no guarantee they will do so.
5. You have to apply every year and wait for coverage
Your coverage is not automatic or indefinite and can be subject to delays.
- Required annual renewal: You must re-apply for the CDCP every year to confirm that you still meet the eligibility requirements. If you miss the renewal deadline, your coverage will end.
- Gap in coverage: If your coverage lapses, any dental services you receive during that gap will not be reimbursed.
- Waiting for your welcome package: Your coverage doesn’t begin until you receive your welcome package from Sun Life, which can take several months. You cannot book an appointment for treatment under the plan until your official coverage start date.
Dental insurance is easy to get and worth it
If you are a resident of Canada, over the age of 18 and covered by a government healthcare plan, you are eligible to apply for coverage. You don’t have to answer any medical questions to apply. The best thing is that by having your own dental insurance coverage in place you can count on it for as long as you pay your premiums. You get steady coverage if you are working full-time, part-time, between gigs or changing projects, no matter what income you earn — your plan is with you every day.
When you get your own dental insurance plan, you can choose the type of dental coverage you need which will cover a portion of dental costs covered per year for:
Basic Dental
For routine oral health maintenance, this coverage includes dental check-ups, fillings, X-rays, and cleanings.
Comprehensive Basic
This coverage includes periodontal treatment of gums and mouth tissue including cleaning and scaling, endodontic root canal therapy, and denture cleaning and repairs.
Major Dental
Includes services to restore teeth including crowns, on lays, dentures, and bridgework.
Orthodontic Dental
Covers services to correct defects and straighten teeth including braces and retainers.
Coverage for your Basic Dental care is available as soon as your health insurance policy is in effect. Other dental coverage may have a waiting period. But whatever coverage you have you can use with the dentist you choose.
Here’s the biggest win – you get coverage for other healthcare costs too
What is amazing is that dental plans don’t just protect you from dental insurance expenses, they also provide a great range of other coverage for healthcare expenses like
- medical equipment including coverage for diabetic medical supplies like, needles and syringes, up to the yearly maximum benefit level (typically from $1000 to $3000 each year)
- vision care
- registered specialists and therapists including chiropractors, chiropodists, naturopaths, registered massage therapists, physiotherapists, acupuncturists and registered psychologists or psychotherapists
- homecare and nursing or personal support workers, therapists, and dieticians
- prosthetic appliances
- accidental dental
- accidental death and dismemberment
- ambulance
- hearing aids
- travel medical insurance.
Take 5 minutes and find out more about dental insurance
At SBIS, we can provide you with a broad range of dental insurance options. We work with GreenShield Canada, GMS, and Manulife to offer competitive rates on coverage that can protect your family’s oral health for years to come. Give us a call or check us out online today.
