Unlike traditional benefit plans, oral health providers must enroll in the Canadian Dental Care Plan to treat patients. You should check with your oral health provider or ensure there is one in your community who plans on enrolling, as participation in the Canadian Dental Care Plan is on a voluntary basis.

There are three main areas that could result in you paying out of pocket:

• Application of co-payments: The Canadian Dental Care Plan covers a percentage of expenses based on your adjusted net family income:
  • Income under $70,000: 100% covered
  • Income $70,000 – $79,999: 60% covered (You pay 40%)
  • Income $80,000 – $89,999: 40% covered (You pay 60%)
• Fee Guide Gaps: The CDCP fee guide is set by the federal government and is typically lower than the BC Dental Association (BCDA) fee guide which most BC dentists follow. For example, a standard check-up may cost $280 under the BCDA guide, but the CDCP guide only recognizes $224. You must pay the difference.
• Excluded Services: The CDCP does not cover all services. If you receive a service not on the CDCP benefit grid, you are responsible for the full cost.

Before receiving oral health care, you should always ask your oral health provider about any costs that won’t be covered by the plan. Make sure you know what you’ll have to pay directly to your oral health provider ahead of receiving treatment. For more information, visit What services are covered.

The CDCP has a defined list of oral health care services with specific limitations. Some major services will require pre-authorization.  Notably, the plan focuses on basic care and has significant gaps compared to Personal Health Insurance, such as:

• Routine Cleaning: CDCP covers 1 unit (15 mins) of scaling, whereas standard care typically requires 4–6 units (60-90 mins).
• Major Dental: Services like ¾ crowns and bridges are not currently covered.
• Extended Health: The CDCP provides no coverage for prescriptions, vision care, or health practitioners (Massage, Physio, etc.).

Details on services covered can be found on the Canadian Dental Care Plan website. More specific information regarding the coverage amounts available for specific services can be found in the Dental Benefits Guide.

It is important to review the eligibility criteria of the Canadian Dental Care Plan:

• Have no access to dental insurance – meaning not available through your employer or that of your family members’ employer benefits, health and wellness accounts, your pension or a family member’s pension benefits or an individually purchased plan.
• Have an adjusted family net income of less than $90,000.
• Be a Canadian resident for tax purposes.
• Have filed your tax return in the previous year.

While the CDCP provides a basic dental safety net for those without insurance, Pacific Blue Cross Personal Health Insurance (PHI) offers more comprehensive protection. In a typical year of care (2 check-ups and 1 filling), an individual earning $85,000 would pay approximately $422 out-of-pocket with CDCP, compared to only $247 with a Pacific Blue Cross plan.

Each year, you will need to meet the eligibility requirements to qualify for the Canadian Dental Care Plan. Your income and access to employer-sponsored insurance will be reassessed annually.