Dental Care Plan: how to avoid surprise charges

The Canadian Dental Care Plan (CDCP) is meant to make dental visits more affordable for people without private insurance. But the federal government’s own guidance is clear on one point: even when the plan pays 100 per cent of its set fees, you may still owe money. Knowing why can save you an unpleasant surprise at the front desk.

Here is how the plan works, according to the Government of Canada, and the questions worth asking before your next appointment.

Who qualifies

To be covered, you must meet all four requirements. First, you have no access to private dental insurance. That includes coverage through work or a pension plan, a family member’s plan, a professional or student organization, or insurance you bought yourself. Health spending accounts that cover dental count too. You are not eligible if you have any dental coverage, even if you have never used it or you pay a premium for it.

Second, you filed your tax return in Canada, and your spouse or common-law partner did too. Third, your adjusted family net income is less than $90,000. Fourth, you are a Canadian resident for tax purposes, and so is your spouse or common-law partner.

Having dental coverage through a provincial, territorial or federal social program does not automatically rule you out. The government says you could still qualify, and the plans may coordinate coverage.

What you pay depends on income

Your co-payment is based on your adjusted family net income:

• Lower than $70,000: the plan covers 100 per cent of CDCP established fees. You pay 0 per cent.
• $70,000 to $79,999: the plan covers 60 per cent. You pay 40 per cent.
• $80,000 to $89,999: the plan covers 40 per cent. You pay 60 per cent.
• $90,000 or more: not eligible.

The key phrase is “CDCP established fees.” The government notes that those fees may not be the same as what a provider charges. If your dentist’s price is higher than the plan’s fee, you can be asked to pay the difference. You may also be billed for any service the plan does not cover that you agree to have done.

What is covered

When recommended by your provider, covered services include exams, x-rays, cleanings, fluoride, sealants, fillings, root canal treatments, gum (periodontal) care, complete dentures, tooth removal and oral surgery. Some sedation options are covered too. Orthodontic services are currently not available.

Some services need pre-approval before you receive them. That list includes crowns, partial dentures and deep sedation, as well as services beyond the usual frequency limits. The government says not all pre-approval requests will be approved, so getting that answer first matters.

Questions to ask before you book

The government’s guidance points to a short checklist:

• Is my coverage active? Check before each appointment.
• Does the provider accept CDCP clients and bill Sun Life directly for covered services?
• What is my co-payment level, and what costs fall outside the plan?
• Does this treatment need pre-approval, and has it been granted?

Also note that the plan only reimburses oral health providers. The government says that if you pay the full cost yourself, CDCP will not reimburse you. Co-payments can also change at renewal, and coverage follows the rules, fees and co-payment in effect on the day you receive the service, so it may differ from an earlier estimate.

You can use any oral health provider in your community, including dentists, dental hygienists, denturists, specialists and dental school clinics. Sun Life, which administers claims, has a provider search tool online, and its contact centre is at 1-888-888-8110.

Applying and renewing

Applications are open for the 2026-2027 benefit period, which ends on June 30. You can apply online through My Service Canada Account or by calling Service Canada at 1-833-537-4342 (TTY 1-833-677-6262). There is no fee to apply or renew, and the government warns people to watch for scams.

You must renew every year. The renewal period for 2025-2026 has closed, and renewals for 2027-2028 are expected to open in spring 2027. People who missed the deadline can re-apply, but the government says there will be a gap in coverage, and dental care received during that gap will not be covered or reimbursed retroactively.

The government’s pages say nothing on how much any given procedure will cost, since fees vary. The most reliable way to find out what you would owe is to ask your provider for a written estimate that spells out what the plan pays and what you pay.

Sources: Canadian Dental Care Plan (Government of Canada); Do you qualify; What is covered; Renew your coverage.

This article is based on official guidance from the Government of Canada’s Canadian Dental Care Plan pages and is provided for general public information. It’s not a substitute for medical advice, if you have questions about how this applies to you, talk to your doctor or pharmacist.

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