Canada is rolling out its dental care program: Here's what you need to know

Ottawa has announced its plans for a permanent dental insurance program for an expanded list of eligible Canadians, after introducing a temporary plan for low-income youth last year. 

The federal government has unveiled the details of a dental insurance plan both the Liberals and New Democrats say is one of the largest social programs to be implemented in Canadian history.

The program, called the Canadian Dental Care Plan, will first open up for seniors over the next six months, at which point eligible youth under the age of 18 and people with disabilities will also be able to apply. All other Canadians who meet the criteria can apply starting in 2025.

Monday’s announcement fulfills a central promise in the governing agreement struck between the minority Liberals and the NDP, which could see the New Democrats prop up Justin Trudeau’s government until 2025 in exchange for progress on shared priorities.

It also expands the list of Canadians who can access the measure, after both parties introduced a stopgap plan for low-income youth last year.

Ottawa has earmarked $13 billion over five years to roll out the program, which the government estimates could help up to nine million Canadians.

Here’s what you need to know about whether you qualify and how to apply.

Who can apply for the program?

If you have no access to dental coverage, your family’s net income is less than $90,000, you're a resident of Canada, and you filed a tax return in the previous year, you qualify for the program.

Not having access to dental insurance means you’re not covered through your employer or a family member’s employer, your pension or a family member’s pension, or a private plan you purchased.

How do I apply?

Health Minister Mark Holland said the program will be rolled out in phases to make sure it can be implemented smoothly.

It will start with eligible Canadians aged 87 and up, who can begin applying this month. Those aged 77 to 86 can start applying in January 2024, followed by those aged 72 to 76 in February. If you’re between the ages of 70 and 71, you can apply in March.

"Those individuals will receive a letter in the mail with instructions on how to enrol. The first group — all those seniors 70 and up — will sign up using the telephone. They will need their SIN number and a unique code that will be included in the letter that will be sent to them in the mail," said Citizens' Services Minister Terry Beech.

"As part of the application, they will have to attest that they don't currently have access to a private or employer family dental plan. Service Canada will then pass on the information of individuals who qualify to third-party administrator Sun Life. Sun Life will then send a welcome package that will include the services that will be covered, a member ID card and the coverage start date."

Government officials, speaking on background Monday, said the government will be able to verify attestations by checking tax records and conducting fraud risk assessments. A call centre will be launched Dec. 18 and will operate throughout the holidays and beyond to field questions.

The process will move over to an online portal starting May 2024, and will open up to seniors aged 65 and up.

In June, anyone with a valid Disability Tax Credit certificate, and eligible youth under 18, can also begin applying online. Everyone else meeting the criteria can apply online in 2025.

The country’s oldest seniors can start visiting a dentist under the plan as soon as May 2024, with start dates for other Canadians beginning afterwards as eligible groups are phased in.

Will I have to pay anything?

You may, depending on your family’s annual income.

If your family’s net income is under $70,000, the plan will cover all your fees.

If your family’s net income is between $70,000 and $79,999, you’ll have a 40 per cent co-payment, meaning the plan will cover 60 per cent of your bill. You’ll have a 60 per cent co-payment if your family’s income falls between $80,000 and $89,999.

What’s covered?

Starting next year, oral health providers can enroll to participate in the program. Those providers include dentists, denturists, dental hygienists, and dental specialists.

A number of procedures and services are covered under the plan, but they need to be recommended by a provider first.

Preventative services (think cleanings) will be covered, along with restorative services like fillings. Root canals, complete and partial dentures, deeper scaling procedures and some oral surgeries, including getting a tooth pulled, will also be captured by the program.

What does this all mean for existing provincial, territorial and private coverage?

Because some Canadians already get a degree of help from provincial and territorial plans, or employer-provided and private options, the federal program has raised questions about what could happen to those types of coverage.

Holland said Monday that he's spoken to his provincial and territorial counterparts and that "they understand this is an opportunity to shove off costs."

As for concerns over whether Canadians might drop their existing private or employer-based plans to get government coverage, Holland underlined that "insurance covers a myriad of different services," such as cosmetic services.

"The intention here is people's oral health, on the basis of getting care that they need," he said, adding that along with the provinces and territories, he's been speaking to businesses about ensuring people don't migrate out of their current plans en masse.

Government officials said earlier in the day they've received no indication that provinces and territories would do away with their plans, stating that the federal program is meant to complement other coverage options to fill the gaps. Officials also said the program is not meant to replace dental benefits offered through employer and pension-based plans or private plans.

Earlier this fall, the heads of provincial and territorial dental associations across the country penned a letter to MPs outlining a number of concerns, including seeking clarification about safeguarding existing plans.

On Monday, nine associations said there's still uncertainty about the newly announced program.

"Recently, the dental associations met with Health Canada to outline this framework and their remaining questions. Today’s announcement reveals that there is still more to discuss and much more work to be done before the plan can launch," their statement said.

By Raisa Patel Ottawa Bureau