What does your dental practice need to know about the Canadian Dental Care Plan?
What does your dental practice need to know about the Canadian Dental Care Plan?
The Canadian Dental Care Plan (CDCP) was introduced to help reduce the financial barriers to accessing dental care. However, you may be wondering what your dental practice needs to know about the CDCP, including:
- What is the CDCP?
- How can I participate in the CDCP?
- What services does the CDCP cover?
- What are the differences between the established CDCP fees and provincial suggested fee guides?
Understanding the answers to each of these questions will help your dental practice take the right steps to navigate the changes the CDCP introduces to the industry.
The Canadian Dental Care Plan (CDCP) was introduced to help reduce the financial barriers to accessing dental care that many Canadians face. One-third of Canadian residents currently don’t go to the dentist due to a lack of insurance, and the CDCP is expected to greatly increase the number of people seeking dental care.
However, you may be asking yourself what you need to know about the CDCP and how it will impact your dental practice. This article provides an overview of what oral health providers need to know about the CDCP — including how to participate in the program, what services are covered, and the differences between established CDCP fees and the provincial suggested fee guides.
What is the CDCP?
The CDCP will replace the interim Canada Dental Benefit, which expires in June 2024. The CDCP will provide full or partial coverage to Canadian residents who access dental services and eligibility is determined by family net income and age group.
While household spending on dental care has increased to an average of $540, public spending on dentistry currently accounts for only 6.4 percent of dental revenue. The amount of people seeking dental care and public spending on dentistry are both expected to increase with the introduction of the CDCP. This is an opportunity for dental practitioners to access a brand-new market that did not previously exist in the industry.
How to participate in the CDCP
Oral health providers can confirm participation in the program to receive direct payment from Sun Life for dental services covered under the CDCP. Those eligible to participate and bill for services include dentists, denturists, dental hygienists, and dental specialists.
Additionally, oral health providers will be able to direct bill Sun Life on a claim-by-claim basis without formally signing up for the CDCP as of July 8, 2024.
Before providing care to CDCP patients, oral health providers will still need to:
- Confirm patient eligibility for the CDCP through their existing patient intake process.
- Confirm the patient is covered for select services.
- Submit a claim with an assignment of benefits. Please note that non-assigned claims will be rejected.
For more information about how to participate in the CDCP as a provider, visit the Government of Canada’s website.
Who does the CDCP cover?
Eligibility for the CDCP is determined by both family net income and age group. The table below displays CDCP coverage by income level:
| Family income |
Coverage % | Remainder % |
|---|---|---|
| $80,000 to $89,999 |
40% | 60% |
| $70,000 to $79,999 | 60% | 40% |
| $69,999 or less | 100% | 0% |
Additionally, availability for the CDCP is determined by age group. The following age groups became eligible to apply for the CDCP on these dates:
| Group | Applications opened |
|---|---|
| Ages 87+ | December 2023 |
| Ages 77 to 86 |
January 2024 |
| Ages 72 to 76 | February 2024 |
| Ages 70 to 71 |
March 2024 |
| Ages 65 to 69 | May 2024 |
The following age groups will be able to apply online for the CDCP on these dates:
| Group | Applications open |
|---|---|
| Ages 18 to 64 with valid Disability Tax Credit (DTC) certificate |
June 2024 |
| Children under 18 |
June 2024 |
| All remaining eligible Canadian residents |
2025 |
Professionals
What dental services does the CDCP cover?
The CDCP provides coverage for a wide range of dental services, including:
- Preventative services — This includes scaling (cleaning), sealants, and fluoride.
- Diagnostic services — This includes examinations and x-rays.
- Restorative services — This includes fillings.
- Endodontic services — This includes root canal treatments.
- Prosthodontic services — This includes complete dentures and partially removable dentures.
- Periodontal services — This includes services such as deep scaling.
- Oral surgery services — This includes extractions.
- Orthodontic services — Coverage for orthodontic services will be available beginning in 2025 for those who meet the clinical criteria and eligibility requirements. Preauthorization will be required for orthodontic treatment.
Some dental services, such as partial dentures and crowns, will require federal preauthorization of payment. Coverage for services requiring preauthorization will begin in November 2024.
What are the differences between the established CDCP fees and provincial suggested fee guides?
The CDCP Dental Benefit Grid (Fee Guide) is divided into sections for general practitioners (GPs) and specialists, denturists, independent dental hygienists, and oral and maxillofacial surgeons. It is important to note that the established CDCP fees are different than provincial suggested fee guides.
The table below is an example of some of the differences between the provincial suggested fee guide for Saskatchewan and the established CDCP fees. The services listed below are also subject to additional conditions. For example, scaling is only allowed at four units in any 12 months in combination with root planning and preauthorization is required for additional units.
| Service code | CDCP dental benefit grid | CDSS abbreviated fee guide |
|---|---|---|
| 01101 – Examination | GP – $55.38 Paed. – $71.13 |
Suggested fee – $65.00 |
| 02102 – Complete radiographs (Adult) | All – $156.59 | Suggested fee – $172.00 |
| 33111 – Root canal (1) |
GP – $538.05 Endo/Paed. – $645.66 |
Suggested fee – $658.00 |
| 11111 – Scaling |
All – $50.00 |
Suggested fee – $52.00 |
Click here to view the CDCP Dental Benefit Grid online. It is crucial to review the grid for your province to understand the key differences that will apply to the dental services you provide.
Take the next steps
The CDCP is an opportunity for more Canadians to access dental care — and provides dental practitioners with access to a brand-new market. It is important for dental practitioners to understand how to participate in the CDCP and take the right steps to navigate the changes it introduces in the industry.
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