The federal government revealed its pioneering dental care strategy on Monday—a substantial $13 billion insurance scheme set to cover routine dental expenses starting next year for individuals meeting specific income criteria.
Initially, Ottawa will extend coverage to individuals below 18 and select seniors, with plans to broaden eligibility to all qualifying low- and middle-income Canadians by 2025.
Applications for individuals aged 87 and older will open later this month, while other age groups can apply in the coming year.
This phased application approach aims to facilitate a seamless rollout, anticipating a substantial influx of participants benefiting from this novel addition to the national social safety net. The coverage implementation will unfold gradually, and eligible participants may start receiving benefits as early as May 2024. It’s crucial to note that costs incurred before the relevant start date will not be covered.
This insurance-centric initiative supersedes the temporary program that, for the past two years, has been disbursing funds directly to families with children under 12.
Addressing System Gaps In a background discussion with journalists, program overseers emphasized that this federal endeavor aims to “bridge the gaps” in the system rather than replace existing provincial and territorial programs already encompassing certain oral health services.
However, the federal government has not secured assurances from provincial leaders regarding the continuity of their programs after the national program’s implementation.
Any decision to dismantle those plans would escalate the cost of the dental care initiative—currently projected to cost the federal treasury approximately $4.4 billion annually.
Eligibility Criteria To qualify for the program, individuals must have a household income below $90,000, lack access to an existing private insurance plan, and have filed a tax return for income verification.
The program is most favorable for households earning below $70,000, with no co-pays for covered services such as cleaning, polishing, examinations, X-rays, fillings, and root canal treatments. Ottawa will cover the expenses entirely.
Families with incomes between $70,000 and $79,999 will face a 40% co-pay, while those in the $80,000 to $89,999 income bracket will contend with a 60% co-pay, with the federal plan covering the remainder of the costs.
Operational Framework Insurance giant Sun Life will administer the program, with dentists submitting claims directly for reimbursement. Any co-payments will be the responsibility of the insured individuals.
Despite third-party management, Service Canada agents will assist individuals with any concerns, including eligibility or coverage disputes, through a dedicated call center for dental services.
The government anticipates engagement from oral health professionals, planning an educational campaign in the new year to guide dentists and their representative organizations on enrolling in the program.
A standardized “fee schedule” for services will be established, with Ottawa’s reimbursed costs varying between provinces. Officials assert that the fees offered are “comparatively generous” compared to other nationwide public plans, aiming to incentivize provider participation.