5 Things Patients Should Know About the CDCP

The Canadian Dental Care Plan, or CDCP, was created to help make dental care more affordable for eligible Canadians who do not have private insurance. It is a great step forward for many families. At the same time, the details can feel a little confusing at first. So, let’s try to make it straightforward and clear, so you know what to expect before your visit.

Here are five important things to keep in mind about the CDCP.

1. You Need to Reapply Every Year

One of the most important things to understand about the CDCP is that coverage does not automatically continue from year to year. Even if you were approved previously, you must renew your eligibility annually to keep your benefits active.

If the renewal process is missed, coverage can lapse. That might result in unanticipated costs if you assume your plan is still in place. Watching for renewal reminders and completing the process early helps avoid gaps in coverage.

Before booking more involved treatment, it is always a good idea to confirm that your renewal has been processed and your coverage is active.

2. Coverage Depends on Your Household Income

The CDCP does not provide identical coverage to every participant. The percentage covered is based on your adjusted family net income as reported on your tax return.

Households with lower incomes qualify for higher levels of coverage. As income increases within the eligible range, a co-payment may apply. That means the plan covers a portion of the approved CDCP fee, and the remaining percentage is the patient’s responsibility.

Because of this structure, two people enrolled in the CDCP may pay different amounts for the same procedure. Reviewing your approval documents can help you understand your specific coverage level before treatment begins.

3. The CDCP Uses a Different Fee Schedule

The CDCP uses its own national fee schedule to determine how much it will pay for each service. Most dental offices do not use this same fee schedule when setting their fees. Because of that, there can sometimes be a difference between what the CDCP covers and the total cost of treatment

This does not mean coverage is denied. It simply reflects that the program calculates reimbursement using its own fee structure. Understanding this ahead of time helps set realistic expectations and reduces surprises when reviewing treatment estimates.

4. Some Services May Require Preauthorization

The CDCP covers many dental services, but certain treatments do require preauthorization before they are approved.

Preauthorization means the treatment plan must be submitted for review to confirm it meets the plan’s clinical criteria. This often applies to more complex procedures, such as certain crowns, periodontal treatments, or major restorative services.

This review process can take time. Planning ahead for these types of treatments helps set clear timelines and realistic expectations.

5. Not All Dental Offices Automatically Participate

Before booking an appointment, confirm that your dental provider participates in the CDCP and will bill Sun Life directly. Sun Life administers claims for the program and pays providers on your behalf.

You should not expect to pay the full amount upfront and be reimbursed later. The plan works through direct billing between the provider and Sun Life, with any co-payment or fee difference paid by the patient at the time of their service.

Confirming participation and understanding any potential out-of-pocket costs ahead of time helps make your visit easier.

What Types of Services Are Covered?

The CDCP is designed to cover a range of essential oral health services. According to the Government of Canada, covered services include:

• Oral exams and assessments
• X-rays
• Cleanings such as scaling and polishing
• Fluoride treatments and sealants
• Fillings
• Root canal treatments
• Certain crowns, under specific conditions
• Complete and partial dentures
• Extractions
• Some periodontal services

Coverage is based on clinical need and the CDCP established fee schedule. Some services are available right away, while others require preauthorization before approval.

If you are unsure whether a specific procedure is covered, it is always helpful to ask in advance so you can understand how the plan applies to your care.

Let’s Make It Simple

The CDCP is a valuable program that helps make dental care more accessible for Canadians without private insurance. Like any benefit plan, it comes with specific rules and guidelines that are important to understand.

Renewing your coverage each year, knowing your income-based co-payment level, understanding the federal fee schedule, and confirming provider participation can make a noticeable effect on how smooth your experience feels.

If you have questions about your CDCP coverage or would like help reviewing your benefits before booking treatment, contact Lakeview Dental today. We are a trusted participant of the CDCP and are here to welcome you to our dental family.