What’s Covered Under the Canadian Dental Care Plan: Are There Any Out-of-Pocket Costs?

The Canadian Dental Care Plan (CDCP) is designed to make dental services more affordable for those who don’t have private dental insurance. One of the key aspects of the plan is that it covers a wide range of services, from routine cleanings to more complex treatments. Depending on your income level, the CDCP can cover up to 100% of eligible services, ensuring that you receive the care you need without significant out-of-pocket expenses. However, for some individuals, co-payments may apply based on their family income. In this blog, we’ll break down what services are covered under the plan, how much is reimbursed, and what co-payments may look like.

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What Services Are Covered by the Canadian Dental Care Plan for Eligible Individuals?

The Canadian Dental Care Plan (CDCP) covers a wide range of essential dental services, ensuring that patients have access to preventive care, treatment for common dental issues, and more complex procedures when necessary. These services fall into several key categories:

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Diagnostic and Preventive Services

These services focus on maintaining oral health and preventing dental issues before they develop into more significant problems. Covered services include:

• Dental exams (complete, routine, specific, and emergency exams)
• X-rays to diagnose underlying issues
• Cleanings (scaling) to remove plaque and tartar
• Fluoride treatments to strengthen teeth
• Sealants to protect teeth from decay, especially for children

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Basic Services

Basic services treat common dental issues such as cavities and gum disease. These include:

• Fillings (both permanent and temporary) to treat cavities
• Root canal treatments to save infected or decayed teeth
• Tooth extractions for severely damaged or diseased teeth
• Pain management for diseased teeth and other dental conditions

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Major Services

For more complex dental needs, the Canadian Dental Care Plan also covers major restorative and surgical services, including:

Restorative Services:

• Crowns (requires preauthorization) to restore heavily damaged teeth
• Posts and post removal for crowns and other dental restorations
• Dentures (complete, partial, or immediate, some requiring preauthorization)
• Denture repairs, relines, and rebases to adjust or restore dentures

Oral Surgery:

• Tooth and root extractions
• Surgical removal of tumours and cysts
• Surgical treatments for broken jawbones
• Incisions for draining abscesses

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Anesthesia or Sedation Services

The plan also covers sedation services to ensure comfort during dental procedures. These include:

• Minimal sedation (conscious sedation)
• Moderate sedation (requires preauthorization)
• Deep sedation and general anesthesia (both require preauthorization)

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Orthodontic Services (Coming in 2025)

Orthodontic services, such as braces, will be added to the CDCP in 2025. These services will only be covered in cases of medical need and will have a maximum spending limit. Strict criteria will apply to qualify for orthodontic treatments.

These categories ensure that patients receive comprehensive care, from preventive treatments to more complex restorative and surgical services. Preauthorization may be required for certain advanced procedures, particularly in the case of major restorative or surgical work.

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How Much is Covered under the Canadian Dental Care Plan?

The Canadian Dental Care Plan (CDCP) offers significant financial assistance, with coverage amounts based on your adjusted family net income. Here’s how the plan divides coverage based on income levels:

• 100% Coverage: For families or individuals with an adjusted family net income below $70,000, the Canadian Dental Care Plan covers 100% of eligible dental services at the plan’s established fees. This means there are no out-of-pocket expenses for routine dental services like exams, cleanings, and fillings.
• 60% Coverage: If your adjusted family net income falls between $70,000 and $79,999, the plan will cover 60% of eligible dental services, with the remaining 40% being your responsibility as a co-payment.
• 40% Coverage: Families or individuals with an adjusted family net income between $80,000 and $89,999 will receive 40% coverage from the CDCP. The remaining 60% must be paid out-of-pocket by the patient as part of the co-payment.

It’s important to note that the plan covers services based on its established fee structure. At Bow River Dental Cochrane, we proudly support the Canadian Dental Care Plan (CDCP) and align our fees with both the CDCP’s established fee structure and the Alberta Dental Fee Guide. This ensures that our patients receive the full benefits of the plan, while minimizing any out-of-pocket expenses. However, in some cases, if a service exceeds the amount reimbursed by the Canadian Dental Care Plan, you may need to cover the difference.

To stay informed about the latest fee schedules, coverage updates, and co-payment details, we recommend checking the official Canadian Dental Care Plan page. This will help you ensure that you’re maximizing your benefits under the plan and avoid any unexpected costs.

Also, be sure to explore our other articles, which cover topics such as eligibility, the application process, and specific benefits for seniors and families with children under the age of 18.

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