The Canadian Dental Care Plan pays on its own fee schedule, not the Ontario one — which is why a 0% co-payment can still leave you with a bill.
The CDCP is a federal dental plan administered by Sun Life on behalf of Health Canada, open to eligible residents of every age now the phased rollout has finished. It has brought a lot of people back into a dental chair after years away. It is a genuinely good program.
It is also widely misunderstood, because the messaging says “covered” without saying “covered at what rate”. Two things can both be true: your co-payment is 0%, and you still owe money at the end of the appointment. CDCP reimburses against its own national fee schedule, which can sit below the ODA Suggested Fee Guide that Ontario practices generally reference, and the difference is not covered.
We are a participating provider — here is how CDCP works at our Windsor office. The rest of this post is the plan itself: who qualifies, what it pays for, and where it stops.
Who Qualifies
Four conditions, all of which must be true at once.
- You have no access to private dental insurance.
- Your adjusted family net income is under $90,000.
- You filed your tax return for the previous year, and so did your spouse or common-law partner if you have one.
- You are a Canadian resident for tax purposes.
The first one causes the most trouble. It says access, not use. If dental coverage is available to you through a job, a pension, a spouse’s plan, a professional association or a student plan, you are disqualified even if you never claim, even if the coverage is poor, and even if the deductible makes it worthless.
Turning the plan down at work does not fix this. Employers report whether dental coverage was made available to you, and that reporting reaches the CRA on your T4. Declining an employer plan to qualify for CDCP does not work and can create a repayment problem later.
Two narrow exceptions: a group plan you pay for entirely yourself, and coverage that lapses through no fault of your own. Check with Service Canada rather than guessing.
The Co-payment Tiers
Adjusted family net income decides what share of the CDCP-approved amount you pay.
| Adjusted family net income | Your co-payment | |
|---|---|---|
| Full coverage | Under $70,000 | 0% |
| Partial | $70,000 to $79,999 | 40% |
| Partial | $80,000 to $89,999 | 60% |
| Not eligible | $90,000 and over | No coverage |
Those thresholds are cliffs, not slopes. A household at $69,800 pays nothing toward the approved amount; the same household at $70,400 pays 40% of it. A modest raise, some overtime or a capital gain in the wrong year moves you a whole tier, and because reassessment is annual, a good year is felt the following year.
The Part Nobody Puts in the Brochure
Your co-payment percentage applies to what CDCP has decided the service is worth, not to what the treatment costs in Ontario.
Where the CDCP schedule sits below the practice’s fee, that shortfall is yours regardless of tier. At 0% you may still pay the gap. At 40% you pay your share of the approved amount plus the gap. Practices must tell you about any uncovered amount before treatment, and you are entitled to that number in writing.
Being straight about this is more useful than pretending otherwise. Ask two questions at the desk: what does CDCP approve for this, and what is the difference. Our fees and payment page explains how estimates work, and if the gap is what stands between you and treatment, say so — there are usually ways around it and we would rather sequence care over two years than have you disappear.
How to Apply
You apply to the Government of Canada, through My Service Canada Account or by phone. Approval comes from Sun Life, which sends a member card and a start date. Nothing is retroactive, so do not book non-urgent work until the card arrives.
A dental office cannot enrol you, speed up your application, appeal it or influence eligibility. Any office implying otherwise is confused. We can check your coverage, submit claims, and tell you what a treatment plan looks like under the plan.
What CDCP Covers
Oral health services on the plan’s list, at the plan’s rates, subject to frequency limits.
- Examinations and diagnostic services, including routine checkups and X-rays at set intervals.
- Preventive care — scaling and polishing, fluoride, sealants for children.
- Restorative work, including fillings and some crowns with preauthorisation.
- Extractions, including surgical removals.
- Root canal treatment, with preauthorisation. Our post on root canal costs in Ontario covers what that means for the total.
- Complete and partial dentures, subject to frequency limits — typically one set per arch within a set number of years.
- Periodontal treatment for gum disease, within limits.
Frequency limits are how the plan controls spending. If you had a cleaning nine months ago and the limit is one a year, the tenth-month appointment is yours to pay for. Ask what your remaining entitlement is rather than assuming it resets in January.
What CDCP Does Not Cover
- Cosmetic treatment. Whitening, veneers and anything under cosmetic dentistry are excluded outright.
- Orthodontics. Braces and clear aligners are not on the plan, so an orthodontic assessment is a private cost.
- Dental implants. Not covered, at any tier. If you are missing a tooth and on CDCP, the plan’s answer is a bridge or a partial denture.
Preauthorisation and What It Does to Your Calendar
Some services need approval first — root canals, crowns, more complex or higher-cost work. The office submits the case with X-rays and notes, Sun Life reviews it, and a decision comes back. It takes as long as it takes.
The consequence is scheduling, not cost. You cannot walk in with a painful molar and have a preauthorised root canal that afternoon. The urgent part usually can happen the same day — draining an abscess, removing the nerve, or an emergency assessment — with definitive treatment booked once approval lands. Start the paperwork the day the problem is found, not the day you decide to proceed.
CDCP Alongside ODSP and Healthy Smiles Ontario
Ontario has its own programs and they do not vanish because a federal plan exists.
ODSP dental coverage continues for adults on Ontario Disability Support Program benefits, and Healthy Smiles Ontario continues for eligible children and youth under 18. Where you qualify for both a provincial program and CDCP, they coordinate and one is billed before the other. Bring every card you have and let the office work out the order.
If you have private insurance instead, you are not eligible for CDCP, but direct billing means you are not paying up front and waiting for reimbursement.
If You Are Denied
Read the reason on the letter, because most denials are administrative. Unfiled taxes, a mismatch between the income on file and your current situation, or a private plan the CRA believes you can access account for most of them.
Fix the record with Service Canada or the CRA and reapply. If circumstances have changed since the tax year assessed — the job with the benefits ended, your income dropped — say so, because there is a process for that. If a specific claim rather than your eligibility is denied, ask the office whether it was a coding issue or a frequency limit. Both are fixable.
Frequently Asked Questions
Is CDCP free?
Under $70,000 in adjusted family net income, your co-payment is 0% of the amount CDCP approves. That is not the same as free — any difference between the CDCP schedule and the practice’s fee is yours. Ask for that figure in writing first.
Can I keep my work insurance and use CDCP for what it does not cover?
No. Access to a private plan disqualifies you entirely; the two do not stack. If your employer’s coverage is weak, use it and ask about payment arrangements rather than dropping it.
Does CDCP cover dentures?
Yes, complete and partial, subject to frequency limits and sometimes preauthorisation. Implant-supported dentures are different, because the implants are excluded.
How long does preauthorisation take?
Days to weeks, depending on complexity and how busy the plan is. Submit as soon as treatment is identified rather than when you are ready to proceed.
Do I need to reapply every year?
Eligibility is reassessed annually against your most recent tax return, so file on time. Your tier can change without you doing anything if your income crossed a threshold.
Can this office sign me up?
No. Applications go to the Government of Canada and approval comes from Sun Life. Once you are enrolled we can check coverage and submit claims.
Come In With Your Card
Bring your CDCP member number to your first appointment. We will confirm coverage, quote the treatment against it, and tell you plainly what is not covered before anything is booked. See what to expect as a new patient, or ask about children’s dentistry.
Book online or get in touch with a coverage question first. Working out costs more broadly? Start with what a crown runs in Ontario. Other coverage and cost questions are answered on the blog.