EXPLAINER: Who Is Eligible Under Newly Announced Federal Dental Care Plan?

Prime Minister Justin Trudeau (C) and ministers Dominic LeBlanc and Ginette Petitpas Taylor speak with dental hygienist students and patients at Oulton College in Moncton, N.B., on March 31, 2023. (The Canadian Press/Ron Ward)

About 9 million Canadians without insurance will soon be able to apply for the federal government’s dental care plan as applications are set to open this month, according to a Dec. 11 announcement, but program participants could still be waiting months to see a dentist.

The Canadian Dental Care Plan builds on an interim program the government started for children under 12 years old.

Details released about the plan indicate that uninsured Canadians with a household income under $90,000 will be eligible for coverage. However, that doesn’t mean these families will no longer pay for dental services as there will be a co-pay requirement.

In addition, starting this month, the program will be registering seniors first, leaving most eligible Canadian adults without coverage until 2025.

Who Is Eligible?

To be eligible, applicants must not have insurance coverage from any other source, have a household income under $90,000, be a Canadian resident, and have filed a tax return in the last year, according to the Canadian Dental Care Plan website.

The plan will be released in phases over the coming months, allowing seniors aged 87 and up to start applying later in December. Those aged 77 to 86 will be able to apply in January 2024. In February, the government will consider applications from those aged 72 to 76. Canadians who are 70 to 71 years old can apply for coverage in March.

The government said they will be sending letters to individuals who are eligible, with instructions on how to apply. Letters will start being sent out in December, according to the government website. All letters will be delivered by the end of March 2024.

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Those aged 65 years and up will be able to apply through an online portal that opens in May 2024, a government news release said.

Applications for Canadians with a valid disability tax credit certificate and children under the age of 18 will be accepted starting in June 2024.

Those between 18 and 64 will need to wait until 2025 to apply for dental coverage through the government’s plan.

The government says that coverage will begin as early as May 2024, depending on when applications are received and processed.

Dental coverage with the government does not mean that Canadians will not pay anything for dental services, as some applicants may be required to co-pay, the website says.

“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. Your co-payment is based on your adjusted family net income.”

According to the government table, those whose income is below $70,000 will not co-pay, those with a household income between $70,000 and 79,999 will pay 40 percent of the service fee, those with income between $80,000 and $89,999 will be required to pay 60 percent of the fees.

There will also be an annual assessment of program participants to ensure that they are still eligible for coverage.

What is Covered?

According to the government website, there are a range of services that will be covered for eligible Canadians. These include:

-Cleaning

-Polishing

-Exams

-X-rays

-Fillings

-Root canals

-Extractions

-Dentures

Program Costs

The program is expected to cost the government $13 billion for the first five years. Ottawa had originally said the program would cost $6 billion.

However, Parliamentary Budget Officer (PBO) Yves Giroux said in June the program would cost more than $10 billion over five years.

Mr. Giroux said his estimates assumed that provinces and territories would continue dental programs they already have in place. He added that his $10 billion estimate “does not account for retreatments” that could occur in the future, such as service coverage changes and amendments to the criteria of Canadians who are eligible to receive dental coverage through the program.

Prime Minister Justin Trudeau previously said the government “underestimated” how many would sign up for the dental care plan, which caused it to change its budget allocation from $6 billion to $13 billion.

Insurance company Sun Life has been contracted for the plan and will be providing cards to eligible Canadians, the government release said.

The insurance plan was part of the Liberals’ supply-and-confidence deal with the New Democrats to secure the opposition party’s support on key votes.

Ottawa intends for the coverage to mesh with existing federal and provincial dental health benefits, according to The Canadian Press. They are still working out with each province who will be the primary payer.

The federal government was already providing some families with children under the age of 12 with financial support under the Canada Dental Benefit, which started issuing payments in October 2022. The program wraps up in June 2024, when parents can apply for the Canadian Dental Care Plan for children under 18.