The federal government unveiled its new dental-care plan on Monday — a $13-billion insurance program that will start covering routine dentistry costs next year for people who meet a certain income threshold.
Ottawa will cover kids under 18 and some seniors first before expanding the program to all eligible low- and middle-income Canadians in 2025.
Applications for seniors aged 87 and over will open later this month. Other age groups will able to apply in the new year.
The staggered application process is designed to make the rollout as smooth as possible. The government says it expects millions of people to avail themselves of this new component of Canada’s social safety net.
Coverage will be phased in over time, but some eligible participants will start to receive benefits as early as May 2024. Costs incurred before the relevant start date will not be covered.
This insurance-based program replaces the interim program that has been sending cheques directly to families with kids under 12 for the last two years.
To be eligible for the program, a person must have a household income below $90,000 and no access to an existing private insurance plan. The person must also have filed a tax return so the government can verify income.
The plan is most generous for families that have household incomes below $70,000. They face no co-pays to a participating dentist, hygienist or denturist, and Ottawa will pick up the tab for covered services like cleaning, polishing, examinations, X-rays, fillings, root canal treatments and complete and partial removable dentures.
Families with incomes between $70,000 and $79,999 will face a 40 per cent co-pay, and for those in the $80,000 to $89,999 income bracket, the co-pay jumps to 60 per cent. The federal plan will cover the rest of the costs incurred.
Health Minister Mark Holland described the government’s plan as “transformative” because it will provide coverage to the nearly nine million Canadians who do not already have access to dental insurance.
Federal Health Minister Mark Holland says a $13-billion dental-care plan will significantly improve access for millions of Canadians who don’t have access to care through workplace insurance plans.
“We know we can have the best health system in the world and today is a monumental step in that direction,” Holland said.
“It’s going to make life better for eligible Canadian residents who won’t have to choose between paying their bills and getting the help they absolutely need,” he said.
Citizens’ Services Minister Terry Beech said Canadians do not need to do anything at this stage — the federal government will reach out to eligible people by mail to invite them to apply for the benefit when it’s their turn.
The first letters will go out to invite seniors 70 and up to apply for the plan — those seniors will apply over the phone.
Here’s when seniors can expect to receive those letters:
- Seniors aged 87 and above starting in December 2023
- Seniors aged 77 to 86 starting in January 2024
- Seniors aged 72 to 76 starting in February 2024
- Seniors aged 70 to 71 starting in March 2024
Then, in May 2024, the application process will switch from the telephone to online as people aged 65 and older become eligible to apply.
People with valid disability tax credit certificates and children under 18 will be able to apply starting in June 2024.
Filling gaps in system
In a background briefing with reporters, senior servants responsible for the program stressed that this federal initiative is meant to “fill the gaps” in the system and not replace existing provincial and territorial programs that already cover some oral health services.
But the federal government has received no assurances from the premiers that they will keep their programs operational once the national program rolls out.
A decision to dismantle those plans would push up the price tag of the dental care plan — in its current form, it is slated to cost the federal treasury about $4.4 billion a year.
Dedicated call centre for queries
The program will be administered by insurance giant Sun Life and dentists will directly submit claims to that company for reimbursement. If there’s a co-pay, insured people will pay that cost out of pocket to the provider.
While the program will be run by a third party, the government said people can still work with Service Canada agents to deal with any issues that arise, including eligibility or coverage disputes. There will be a dedicated call centre to deal with dental services.
The government is hopeful that oral health professionals will enrol in the program and accept the Canadian dental-care insurance plan as payment.
Officials said the government will launch an education campaign to brief dentists and the organizations that represent them in the new year on how they can sign up to provide covered care.
There will be a set “fee schedule” for services — but the costs reimbursed by Ottawa will vary from province to province.
The government said the fees paid are “relatively generous compared to other public plans across the country,” which should provide an incentive for providers to participate.