Find all the answers you need in this blog article from Swiss Denture Calgary
Oral health is essential to Canadians’ overall health, but oral health care can be expensive. A third of people living in Canada do not have dental insurance, and, in 2022, one in four Canadians reported avoiding visiting an oral health professional because of the cost.
Poor oral health can lead to respiratory disease, diabetes complications, cardiovascular disease, stroke, cancer, pregnancy complications, life-threatening infections, and greater mortality from all causes. It can also lead to related mental health issues, reductions in quality of life, and, in extreme cases, employment challenges, social shame, nutritional issues and isolation.
The Government of Canada is committed to making life more affordable for Canadians. Budget 2023 outlined the Government of Canada’s plan to build a healthy future for Canadians from coast to coast to coast by investing $13 billion over five years, and $4.4 billion ongoing to implement the Canadian Dental Care Plan (CDCP).
Once fully implemented, the CDCP will help ease financial barriers to accessing oral health care for up to nine million uninsured Canadian residents with an annual family income of less than $90,000.
Oral health professionals like Swiss Denture in Calgary play a vital role in delivering oral health care, and this plan will allow more Canadians to receive their care. Resources and tools on how to assist and inform their patients about the CDCP will be provided to the oral health professional community.
The CDCP is not intended to be a replacement for existing dental benefits offered through employer/pension-sponsored or private plans. However, it is intended for the CDCP to fill existing gaps in coverage and complement existing provincial and territorial dental programs.
The Government of Canada has engaged provinces and territories on the CDCP and is encouraging them to maintain their existing dental programs and to continue investing in oral health. The Government of Canada is committed to working with provinces and territories, as well as oral health care professionals, to ensure that Canadians continue to have access to affordable, accessible, and essential oral health care.
Who qualifies?
To qualify for the CDCP, the following criteria must be met:
- no access to dental insurance
Footnote*; - an adjusted family net income of less than $90,000;
- be a Canadian resident for tax purposes; and
- have filed their tax return in the previous year.
Canadian residents who have access to dental benefits through a social program offered by their province or territory and/or by the federal government will be eligible for the CDCP if they meet all the eligibility criteria.
When applications open
Applications will first open for seniors aged 87 and above in December 2023, expanding in phases to those aged 77 to 86 in January 2024, followed by those aged 72 to 76 in February 2024, then those aged 70 to 71 years in March 2024.
Individuals in these age groups who may be eligible will receive letters inviting them to apply, with instructions on how to validate their eligibility and apply by telephone.
In May 2024, an online application portal will open for seniors 65 and older. Persons with a valid Disability Tax Credit certificate and children under the age of 18 will be able to apply online as of June 2024. All remaining eligible Canadian residents will be able to apply online in 2025.
Group Applications open
Seniors aged 87 and above | Starting December 2023
Seniors aged 77 to 86 | Starting January 2024
Seniors aged 72 to 76 | Starting February 2024
Seniors aged 70 to 71 | Starting March 2024
Seniors aged 65 to 69 | Starting May 2024
Persons with a valid Disability Tax Credit certificate | Starting June 2024
Children under 18 years old | Starting June 2024
All remaining eligible Canadian residents | Starting 2025
How to apply?
Canadian residents who may qualify will be able to apply to the CDCP through Service Canada.
Starting in December 2023, letters will be mailed to potentially eligible seniors informing them that they may qualify for the plan and inviting them to apply. This letter will include a personalized application code and instructions on how to apply.
Only those who meet the following criteria will receive a letter with instructions on how to apply:
- are 70 years old, or will be 70 years old or older by March 31, 2024;
- have an adjusted family net income less than $90,000 based on their and/or their spouse’s or common-law partner’s 2022 tax returns; and
- were a resident of Canada in 2022 for tax purposes.
From December 2023 until end of April 2024, seniors who receive invitation letters may call Service Canada to apply via an automated Interactive Voice Response (IVR) system. When applying, they will be asked for two pieces of identification and whether they currently have access to any type of dental benefits. The applicant will immediately be notified whether they have been successful in applying and are eligible. They will also receive a letter confirming this information.
Seniors aged 65 to 69 years and seniors who received a letter but were not able to apply by phone will be able to apply online starting in May 2024, followed by persons with a valid Disability Tax Credit certificate and children under the age of 18 years in June 2024.
Once an individual is determined to be eligible, Service Canada will share the applicant’s information with Sun Life, the contracted service provider, for the purpose of enrolment into the CDCP. Sun Life will enrol eligible applicants in the CDCP and will send them a welcome package, including information on the CDCP, coverage details, their member card, and the start date of their coverage.
Canadians who are enrolled in the CDCP will be able to start seeing an oral health provider as early as May 2024, starting with seniors. The start date to access oral health care will vary based on when each group can apply, when the application is received and when enrolment is completed.
Appointments with an oral health provider like Swiss Denture Calgary should be scheduled as of their coverage start date, and no sooner, for the oral health care services to be covered under the plan. The CDCP will not reimburse oral health care services received before the start date provided in the welcome package from Sun Life.
What is covered?
To improve oral health outcomes, the CDCP will help cover the cost of various oral health care services, on the recommendations of an oral health care provider, when needed.
Services that could be covered under the CDCP include the following, with some services only becoming available in fall 2024:
- preventive services, including scaling (cleaning), polishing, sealants, and fluoride;
- diagnostic services, including examinations and x-rays;
- restorative services, including fillings;
- endodontic services, including root canal treatments;
- prosthodontic services, including complete and partial removable dentures;
- periodontal services, including deep scaling;
- oral surgery services, including extractions.
Health Canada is collaborating with provinces and territories regarding public oral health services, including the coordination of benefits between the CDCP and provincial and territorial publicly-funded programs.
As part of a continuous improvement approach, the CDCP will be reviewed regularly based on data and evidence to ensure it meets the needs of Canadians.
How much will be covered?
The CDCP will help ease financial barriers to accessing oral health care for Canadian residents who do not have access to dental insurance. To limit the out-of-pocket expenses for people covered under the CDCP, oral health providers who enrol as service providers in the CDCP and provide oral health care services will bill the CDCP directly for reimbursement rather than having patients seek reimbursement from Sun Life.
The CDCP will reimburse a percentage of eligible expenses at the established CDCP fee rates. A co-payment is the percentage of CDCP fees that is not covered by the CDCP, and that people covered under the CDCP will have to pay directly to the oral health provider.
The percentage of co-payments will depend on the adjusted family net income as follows:
- no co-payment for those with an adjusted annual family net income under $70,000;
- a 40% co-payment for those with an adjusted annual family net income between $70,000 and $79,999;
- a 60% co-payment for those with an adjusted annual family net income between $80,000 and $89,999.
Oral health providers are encouraged to follow the CDCP established fees, which are not the same as the provincial and territorial fee guides, so that their patients do not face additional charges at the point of care.
The Role of Oral health providers
In early 2024, oral health providers will be able to enrol, on a voluntary basis, to the CDCP as participating CDCP oral health providers directly with Sun Life. A provider awareness campaign will be launched, with the support of Sun Life, that will invite providers to enrol.
Providers who are licensed and in good standing to practise in the province or territory where the services will be given will be able to enrol in the CDCP.
Eligible oral health providers include:
- dentists;
- denturists;
- dental hygienists; and
- dental specialists.
Why this is important: State of oral health care
Oral health is an important part of our overall health and well-being. Regular visits to an oral health professional can prevent and reduce many oral health care concerns. Oral health-related illnesses are currently impacting our health care system and our overall economy:
- Patients with no access to dental insurance visit emergency rooms for non-urgent dental conditions, although their issues are rarely solved by emergency care. These avoidable visits cost the health care system an estimated $1.8 billion in 2017.
- An estimated 2.26 million school days and 4.15 million working days are missed each year due to oral health concerns.
- Individuals with gum diseases are 2 to 3 times more likely to have a heart attack or stroke than those with healthy gums.
- Dental surgery under anaesthesia accounts for one-third of all day surgeries performed on children between ages 1 and 5 years at pediatric hospitals; many of these surgeries could have been prevented if oral health care was available early on.
Not having access to dental insurance is defined as
- not available through your employer or a family member’s employer benefits; including health and wellness accounts;
- not available through your pension (previous employer) or a family member’s pension benefits; or
- not purchased by yourself or by a family member or through a group plan from an insurance or benefits company.
Jennifer Auld, Denturist at Swiss Denture Calgary:
We provide life changing solutions for those with missing teeth. At our Calgary Denture Clinic, we provide comprehensive information on affordable dentures in Calgary and the options available to those who are missing one or more teeth.
We understand that the decision to consider dentures can be a difficult one, as it can be difficult to come to terms with the idea of having false teeth. However, we want to assure you that dentures can be a life-changing solution.
Still Having Questions? Contact us today. We are happy to help!
Resource: Health Canada
