The federal government revealed on Monday details of its new Canadian dental care plan, based on the existing Canadian Dental Benefit, noting that access to oral health care should not depend on a person’s ability to pay.

While the first version of this program was offered only to children, with officials working behind the scenes to set up a full national dental care plan, this new insurance program will be available to up to nine million low-income and uninsured Canadians from across the country, and for all ages once fully launched in 2025, according to government estimates.

To implement this public program, the federal government allocated $13 billion over five years, starting this year, with an annual budget of $4.4 billion beginning then, but there are many nuances in this major announcement, including how and when Canadians can access this support, so here’s what you need to know.

Who is eligible?

To qualify for the Canadian Dental Care Plan (CDCP), you must meet the following criteria:

  You must be a resident of Canada and not have dental insurance;

  Have an adjusted net family income of less than $90,000 CAD; and have filed your tax return for the previous year.

According to the government, Canadian residents who have access to a regional dental benefit program are eligible. The government information page stated: “In this case, coverage will be coordinated to ensure no duplication and to avoid gaps in oral health care.”

The Canadian government will consider not having dental insurance to mean:

  Coverage is not available through your private employer or employer benefits for a family member;

  Coverage is not available through your pension or pension benefits for a family member; or

  Coverage has not been purchased individually or for a family member or through a group plan.

Children under 18 will have their eligibility determined based on the eligibility of their parents or guardians.

On Monday, Health Minister Mark Holland said, “This is the largest coverage in Canada’s history,” for everyone, with eligibility reassessed annually.

Phased rollout

Given the scope of this new dental plan, and in an effort to ensure as smooth a rollout as possible initially, the government has decided to provide access to this new coverage in phases.

Seniors will be the first to gain access.

Starting December 2023, enrollment will open for seniors aged 87 and over, with those aged 77 to 86 eligible to apply in January 2024, in February seniors aged 72 to 76 will gain access, followed by those aged 70 to 71 in March, and seniors aged 65 to 69 can apply in May.

After that, Canadians with a valid disability tax credit certificate, as well as children under 18, will be able to start applying from June 2024.

All remaining eligible Canadians are expected to gain access in 2025.

How will applications work?

In general, as Citizen Services Minister Terry Beech said on Monday, Canadians only need to make sure they have filed their taxes.

To start, seniors who may be eligible will receive letters by mail inviting them to apply through Service Canada, with information on how to verify their eligibility and apply by phone using an automated interactive voice response system.

“This letter will include a personal application code and instructions on how to apply,” according to briefing materials provided to reporters on Monday.

How can you know if you should be watching for one of these letters? If you are 70 years or will turn 70 by March 31, 2024; if you meet the income threshold based on your 2022 tax filing; and if you were a resident of Canada for tax purposes that year.

Applicants completing the phone process will be immediately notified whether they are eligible and if their application was accepted.

Initial applications will be accepted online—through a portal not yet created—from May 2024 for age groups allowed to apply by then. Once this online system launches, all future applications will be accepted through it.

Parents and caregivers already using the Canada Dental Benefit system can continue using the application process managed by the Canada Revenue Agency until it’s their turn to benefit from the expanded system starting June 2024. Here is some additional information about this current benefits program.

What will be covered?

According to the government, “a wide range of oral health care services” will be covered, including preventive dental procedures such as cleaning, polishing, and fluoride treatment.

Diagnostic services like exams and x-rays are also expected to be covered, along with more complex procedures such as cavity fillings, dentures, and root canals.

Through the CDCP, oral health providers are expected to bill directly to the federal plan administered by Sun Life, rather than requiring patients to pay out of pocket first and then request reimbursement afterward.

However, not all applicants will qualify for 100% coverage.

The CDCP will cover a percentage of eligible expenses depending on applicants’ income level, with the rest being a cost-sharing payment with the patient. For example:

  Canadians with an adjusted annual family income under $70,000 will have no cost-sharing;

  Canadians with an adjusted annual family income between $70,000 and $79,999 will have a 40% cost-sharing payment; and Canadians with an adjusted annual family income between $80,000 and $89,999 will have 60% cost-sharing.

“Cost-sharing is the percentage of CDCP fees not covered, and people under the CDCP will have to pay oral health providers directly.”

When will coverage start?

If you have read all the above and are now wondering when you can start submitting dental care claims, you might want to hold off planning coverage for any upcoming appointments.

While the start date to access this system will depend on when you become eligible to apply and complete your registration, seniors in the program will be able to see an oral health provider “as early as May 2024.”

Once Service Canada considers an applicant eligible, their information will be shared with the insurer. Sun Life will then handle the registration process and notify Canadians of their specified coverage start date, plan details, and accompanying membership card via a welcome package.

“Your coverage will start on the date specified in the welcome package you receive from Sun Life. Appointments with oral health providers must be scheduled from that date onwards, not before, for eligible oral health care services to be covered under the plan, “the CDCP will not compensate you for oral health care services received before the start date.”

Finally, when it’s time to book an appointment, Canadians will have to ask their oral health care provider if they are registered in the federal plan, as there are also registration requirements for dentists and health professionals.