Insuring Your Smile in 2024: Does the CDCP Cover Orthodontic Treatments and Invisalign?

All of us are aware that oral health is an important part of our overall well-being. Regular dental check-ups significantly help reduce the risk of dental decay, gum disease, and other oral health issues. Ignoring oral health can ultimately lead to diseases like cardiovascular disease, stroke, etc.

Despite the important role of orthodontic treatment and oral health in our overall well-being, one-third of Canadians don’t have dental insurance. Sadly, one in four Canadians avoid visiting a dental professional due to the high costs.

However, we have good news for you. The Canadian Dental Care Plan (CDCP) aims to ease financial barriers to accessing dental healthcare for uninsured Canadian residents with an annual net income below $90,000.

In this article, we’ll delve into this plan and explain its details for you.

Who Qualifies for the Canadian Dental Care Plan (CDCP)?

To qualify for the CDCP, you must meet the following criteria:

• Not having the opportunity to access dental insurance
• Be a resident of Canada and have filed a tax return in the previous year
• Have an annual net income of less than $90,000

What does not having access to dental insurance mean?

It simply means you do not have access to any type of dental insurance or coverage through:

• A professional or student organization
• Your employment benefits or a family member’s employment benefits, including health and wellness accounts

• Your pension benefits or a family member’s pension benefits (including federal, provincial, and territorial government employer pension plans)
• Coverage purchased by you or a family member or through a group plan from an insurance or benefits company

Notes:

1. If you’re eligible for dental coverage through employment benefits or professional/student organization, you’re not eligible for a Canadian Dental Care Plan (CDCP), even if:

• You don’t use it
• You have to pay a premium for it
• You decide not to take it

2. If you take advantage of pension benefits or a family member’s pension benefits, you’re not eligible for CDCP, unless you’re retired and:

• You opted out of pension benefits before December 11, 2023
• You can’t opt back in under the pension rules

3. If you purchased private dental insurance (not as part of the coverage described above), you’re not eligible for the CDCP while that coverage is in effect.
4. If you have dental coverage through a provincial, territorial, or federal government social program, you may still qualify for the Canadian Dental Care Plan (CDCP). Your coverage will be coordinated between plans to ensure no duplication or gaps.

When to Apply for the CDCP?

The CDCP is being implemented in phases over several months, with seniors as the initial beneficiaries.

 How to Apply for the Canadian Dental Care Plan (CDCP)?

Starting in December 2023, potentially eligible seniors began receiving letters inviting them to apply for the Canadian Dental Care Plan (CDCP). These letters include personalized application codes and detailed application instructions. To receive a letter, seniors must meet the following criteria:

• Be 70 years old or older by March 31, 2024
• Have an adjusted family net income below $90,000, based on their or their spouse’s/common-law partner’s 2022 tax returns
• Have been a Canadian resident for tax purposes in 2022

From December 2023 to the end of April 2024, eligible seniors may apply via an Interactive Voice Response (IVR) system by calling Service Canada. During the application process, you’ll need to provide two forms of identification and confirm whether you currently have access to dental benefits. Successful applicants will be notified of their eligibility immediately and receive a confirmation letter.

Starting in May 2024, seniors aged 65-69 and those unable to apply by phone can apply online. In June 2024, individuals with a valid Disability Tax Credit certificate and children under 18 will be eligible to apply.

What Is Covered By the Canadian Dental Care (CDCP)?

Based on Canada.ca/dental, the CDCP will cover a wide range of oral health, including:

• Oral Surgery services, including extraction
• Restorative services, including fillings
• Diagnostic services, including examinations and x-rays
• Preventive services, including scaling (cleaning), sealants, and fluoride
• Endodontic services, including root canal treatments
• Periodontal services, including deep scaling
• Prosthodontic services, including complete and partial removable dentures

Notes:

Health Canada is working with provincial and territorial governments to coordinate the Canadian Dental Care Plan (CDCP) with existing publicly-funded oral health programs. This collaboration ensures seamless integration of benefits and avoids duplication of coverage.

To maintain the CDCP’s effectiveness and relevance, the program will undergo regular reviews based on data and evidence. These reviews will help identify opportunities for improvement and ensure the CDCP continues to meet the oral health needs of Canadians.

How Much the CDCP Program Is Covered?

Under the Canadian Dental Care Plan (CDCP), participating dental providers receive payments directly from Sun Life for covered services. CDCP fees may differ from fees suggested by provincial or territorial oral health associations.

CDCP patients may need to pay additional charges if:

• Their adjusted family net income is between $70,000 and $89,999, requiring a co-payment
• Their dental provider charges more than CDCP fees
• They agree to services not covered by the CDCP

Co-payments are determined by adjusted family net income:

• No co-payments for incomes below $70,000
• 40% co-payment for incomes between $70,000 and $79,999
• 60% co-payment for incomes between $80,000 and $89,999

Notes:

CDCP patients should confirm any uncovered costs before receiving oral health care. Patients are responsible for paying the full cost of services not covered by the CDCP.

CDCP does not cover appointment cancellation or no-show fees, so patients must pay these fees themselves.

Benefits of Canadian Dental Care Plan (CDCP) at a Glance

Statistics show that most adults in Canada, between 60 to 79 years old, experiencing cavity and gum disease. Sadly, 16% of those leave untreated tooth decay.

Generally, as we age, our oral health can be affected by various factors, including:

• Sensitive teeth: Teeth may become sensitive to hot, cold, or touch.
• Dry mouth: A lack of saliva increases the risk of tooth decay.
• Exposed roots: Gums can pull away from teeth, exposing roots to harmful bacteria.
• Tooth loss: Older adults are more likely to lose natural teeth.

How CDCP Helps Seniors

CDCP covers various oral health services to address seniors’ common issues:

• Tooth decay, gum disease, and sensitivity: CDCP covers fillings, root canals, examinations, X-rays, and preventive treatments.
• Tooth loss: CDCP covers complete and partial removable dentures (with preauthorization).
• Limited autonomy and dexterity: CDCP covers some oral hygiene care in institutional settings.

For more information on CDCP eligibility, application process, and coverage details, visit Canada.ca/dental.

Services Covered by the Canadian Dental Care Plan (CDCP)

 How Easy Is It to Confirm Participation for the CDCP?​

FAQ

Does CDCP cover Orthodontic Services?

Some orthodontic services will be added to the CDCP starting in 2025. Orthodontic services will only be covered in cases of medical need based on stringent criteria and will include a maximum spending limit.

Does CDCP cover Invisalign Cost?

Starting in 2025, the Canadian Dental Care Plan (CDCP) will include coverage for some orthodontic services. Please note that orthodontic treatments like Invisalign, metal braces, or Invisaign retainers will only be covered by CDCP in cases of medical necessity, based on strict criteria.

Does insurance cover invisalign?

Yes, many insurance plans cover various orthodontic treatments, including Invisalign. Here are some examples:

• Canada Life: If your policy includes orthodontic coverage, it would likely covers Invisalign treatment.
• Pacific Blue Cross: Through employer plans, they cover the cost of orthodontic treatments like Invisalign, up to 60%
• Manulife: Policies covering orthodontic treatment may include Invisalign coverage, up to 50%.
• Sunlife: Covers 90% of Invisalign costs. This insurance is typically provided by employer.
• Green Shield Canada: Covers 50% of orthodontics (including Invisalign) up to a lifetime maximum of $5,000.
• OTIP: Similar to Green Shield Canada, it provides with a life time maximum.

Bottom Line

At York Orthodontics, we believe it’s our responsibility to raise awareness in the community about the significant role oral health plays in overall well-being. We’re committed to sharing the latest news and information to help improve community health.