Access to proper and effective dental care is essential for maintaining not just a healthy smile, but also excellent overall health and wellbeing. But, for many Canadians, the cost of dental services can be a barrier.
In response, the government introduced the Canada Dental Care Plan (CDCP). The goal of this program is to provide financial relief and improve access to dental care for individuals and families across the country who are within a certain income bracket.
Carry on reading to learn more about the Canada Dental Care Plan including its key features, eligibility criteria, services covered, plan access and limitations, and where to find a dental office that
Understanding the Canada Dental Care Plan (CDCP)
The Canada Dental Care Plan is a government initiative aimed at providing accessible essential, preventive, and emergency dental care for individuals and families who struggle to afford them. This includes those in the low- to middle-income households or those who do not have access to private or employment insurance.
What sets the CDCP apart from provincial or private insurance is its national scope and focus on income-based eligibility. Also, while private insurance often requires premium or monthly payments, the CDCP is made more accessible by providing full or partial coverage on a wide range of treatments depending on the income status.
Eligibility Criteria for the Canada Dental Care Plan (CDCP)
While this program aims to provide financial aid for several Canadian citizens, not everyone can receive it. Here is a checklist of the eligibility criteria to help you determine if you are qualified:
- Income Requirements – The CDCP is primarily targeted toward individuals and families with a household income of less than $90,000.
- Age Requirements – The plan is open to all ages, but prioritizes seniors (age 65+) and children.
- Lack of Private Dental Insurance – The CDCP is designed for individuals without private dental insurance, whether through employer, school or university, private, or other government plans.
- Residency – This program is open to Canadian citizens only for tax purposes.
How to Apply for the Canada Dental Care Plan
As of writing, seniors 65 and above, adults age 16-64 with valid Disability Tax Certificate, and children under 18 years should have already received their invite to apply. All remaining eligible Canadian residents will receive their invites starting 2025.
If you have received this invite letter, you can start your application as follows:
- Check your eligibility – To check if you qualify for the CDCP, you can use the government’s online eligibility checker. This lists the eligibility criteria for the program. If you tick all the boxes, you can immediately apply online provided that you have the necessary documents.
- Submit application – The best and easiest way is to apply online. Simply click the link available in the CDCP website, fill out the form, and attach the corresponding documents. But if this is not available to you, you may apply by phone via 1-833-537-4342 and select option 1 to complete your application.
- Wait for approval – You should receive your plan information after a few weeks. Until then, you may check your status using the status checker tool available online. You may also contact 1-833-537-4342, select option 2, and a representative will be available to assist you.
- Confirmation of Enrolment – Your coverage will begin on the date provided in your welcome package from Sun Life, the official partner of the CDCP. This should arrive within 3 months from your application.
Once you have received your confirmation, you can start maximizing your benefits by looking for a participating provider or clinic. This is available in the online directory provided by Sun Life. From the list, contact your chosen oral health provider so they can verify your coverage. Then, you can book your appointment for any eligible service. Make sure to bring your proof of eligibility and identification on your appointment.
Services Covered Under the CDCP in SW Calgary
The Canada Dental Care Plan covers a wide range of essential, preventive, and emergency dental services, including:
- Diagnostic and Preventive Services – Dental exams, X-rays, dental cleaning, fluoride application, sealants
- Restorative Services – Fillings, crowns and crown repair, post and core
- Endodontic Services – Root canal treatment, pulpectomy, re-treatment of previously completed root canal
- Periodontal Services – Root scaling and planing, treatment of abscesses, non-surgical gum disease management
- Prosthodontic Services – Complete and partial denture, denture repairs, denture liners, overdentures
- Oral Surgery Services – Tooth extraction, removal of tumours and cysts, incision and drainage, treatment of broken jaws
- Anaesthesia and Sedation – including general anaesthesia
Not all the listed services are readily available for treatment coverage. Some procedures may require pre-authorization where a request for coverage is done prior to proceeding with the treatment.
In addition to knowing the services covered, it is important to understand the terms of the plan. Here are some key points to know:
CDCP Established Fees
The CDCP has pre-set, established fees for each of the dental services that they cover. This represents the maximum amount that the plan will pay for the specific treatment done.
What does this mean for plan holders?
Co-payments
According to the plan, individuals or families with an adjusted family net income lower than $70,000 are entitled to 100% coverage of eligible oral health care costs established by the CDCP.
For those with an adjusted family net income between $70,000 and $79,999, the CDCP will cover 60% of the established fees, with 40% as co-payment. Meanwhile, for an adjusted family income between $80,000 and $89,999, the CDCP will cover 40% of the established fees, and the remaining 60% as co-payment.
Out-of-pocket Expenses
You may be entitled to additional costs if the payment required by your chosen participating dental clinic is more than the CDCP established cost. For example, the CDCP covers $134 for 2 units of scaling. If your clinic charges $145, you will have to personally pay the difference of $11 to your provider.
Frequency Limitations
Dental services that are covered by the CDCP may only be received for a certain number of times within a specific period. These limits are designed to ensure that care is provided without overuse of services, helping manage the costs for all planholders and the government. In excess of these limitations, the CDCP will not cover the treatment done.
Understanding the CDCP’s fee structure and co-payment plan ensures you can make informed decisions about your dental treatment and avoid unexpected charges. Always check with your dental provider and clarify the corresponding costs before undergoing treatment.
Conclusion
The Canada Dental Care Plan provides a valuable opportunity for SW Calgary residents to access affordable and necessary dental services. By understanding your eligibility, knowing what services are covered, and following the steps to apply, you can take advantage of this program to prevent dental diseases and maintain and improve your oral health and well-being.
If you think you may qualify for the CDCP, we encourage you to contact us today at Springbank Hill Dental to book your appointment and explore your options.