Canadian Dental Care Plan

Last updated

The Canadian Dental Care Plan is a dental insurance program funded by the Government of Canada to provide dentistry services to uninsured Canadians that meet certain criteria. [1] It replaces a temporary dental benefit program established in 2022 for children under 12 who did not have dental insurance coverage, which will be terminated in June 2024. [2]

Contents

In the 2022 federal budget, the impending program was estimated to cost $1.7 billion annually. [2] The 2023 Canadian federal budget allocated $23 million over two years to collect oral health data for use of the program, [2] $13 billion for Health Canada to implement the program over five years, and $4.4 billion annually thereafter for program costs. [3] [2]

The program began its staggered enrolment rollout in December 2023 with mailings to individuals at least 87 years old. [1]

Background

The 2021 Canadian federal election resulted in a minority government for the incumbent Liberal Party of Canada led by Justin Trudeau, establishing the 44th Canadian Parliament. [4] Six months later, the New Democratic Party of Canada (NDP) led by Jagmeet Singh formed a confidence and supply agreement with the Liberal Party to ensure the latter would govern until 2025. [5] The NDP support was contingent on the Liberals agreeing to a set of priorities for the session of Parliament, among them to establish national dental care and pharmacare programs. [6] The dental care program had been a long-standing priority for the NDP, [7] which had campaigned during the 2019 and 2021 Canadian federal elections to implement such a program if elected. [8]

In 2020, the Parliamentary Budget Officer estimated it would cost $1.3 billion to implement a similar program. [8] The first year of the program was expected to cost $4.3 billion as those with "unmet dental needs" would obtain care as soon as they became eligible for it. [8]

Heather Carr, president of the Canadian Dental Association, has stated that dentists have wanted a national plan for dental care coverage. [9] About 35% of Canadians do not have private dental care insurance, including more than half of seniors. [10] They would incur an out-of-pocket expense for dental care, which may result in those individuals avoiding dental care. [10]

In 2014, patients with no dental care coverage made over 60,000 visits to emergency departments for oral health issues, resulting in a cost of over $30 million to the health care system. [11] The costs are exacerbated by the fact the departments lack the tools and medical staff the training to provide such service. [11]

Program

The program was modelled on the Non-Insured Health Benefits Program provided by the federal government to First Nations and Inuit people. [12] Officials stated that complaints about that program, particularly about excessive paperwork for dental clinics, were addressed for the creation of the Canadian Dental Care Plan. [13] In the latter stages of its creation, Minister of Health Mark Holland stated that Health Canada had begun consultations with the Canadian Dental Association and other groups that had agreed to sign a confidentiality agreement, but that provincial and territorial dental associations had refused to sign such agreements. [14]

It is delivered in three phases. [15] The first phase established the temporary Canada Dental Benefit in December 2022 that provided the parents or guardians having an adjusted net income less than $90,000 of children 12 years old and younger who do not have dental coverage a $650 tax-free payment per child each year. [15] Members of Parliament from the Bloc Quebecois and Conservative Party of Canada voted against establishment of the program. [16]

The second phase was the establishment of the Canadian Dental Care Plan providing coverage to individuals less than 18 years old, those over 65 years old, and those with disabilities. [15] During this phase, starting in December 2023 and completing in December 2024, parents of children less than 12 years old can obtain benefits from both the Canada Dental Benefit and the Canadian Dental Care Plan. [15]

The third phase will extend the benefits program to all individuals with a net adjusted family income less than $90,000 and having no dental insurance. [15] This phase is expected to provide dental benefits to 8.5 million Canadians and improve dental benefits for 1.4 million Canadians; another 4.4 million will not be covered because they have a net adjusted family income of more than $90,000. [17]

A fixed-fee schedule will be established that will depend on both the service provided and the province in which it is provided. [18]

Eligibility

Applicants for the Canadian Dental Care Plan must have a net family income less than $90,000, have no other dental insurance coverage (excepting those provided by provincial or territorial governments or the federal government), must be a Canadian resident, and must have filed a tax return the year preceding coverage in the program. [1] Eligible individuals will receive a letter inviting that individual to apply for the program. [1] Once enrolled, eligibility will be verified annually. [1]

Applicants must have an adjusted family net income of less than $90,000. [1] This is calculated by subtracting universal child care benefits (UCCB) and registered disability savings plans (RDSP) from net income exclusive of amounts repaid for those programs. [1] In order to determine eligibility, all employers and pension plan administrators must include on T4 and T4A income tax forms whether the individual or members of their family had access to dental insurance benefits for the reporting tax year. [19] On the T4 form, this will be box 45, and on the T4A form it will be box 015, both of which will specify a code to indicate the scope of coverage available to the individual. [20]

Applications opened for eligible individuals to apply by telephone in December 2023 for those who were 87 and older, in January 2024 for those between 77 and 86 years old, in February 2024 for those between 72 and 76 years old, and in March 2024 for those between 70 and 71 years old. [18] In May 2024, individuals between 65 and 69 years old can submit applications, and the online application system will be launched. [18] In June 2024, applications will be accepted from individuals 18 years old or younger and adults with a Disability Tax Credit certificate. [18] All other eligible Canadians can submit applications in 2025. [18]

Once an individual's eligibility is approved by Service Canada, their personal information will be forwarded to Sun Life Financial to complete the enrolment process. [21]

Services

Oral health services covered by the plan include preventive services, diagnostic services, restorative services, endodontic services, prosthodontic services, periodontal services, and oral surgery. [1] It will not cover cosmetic dentistry services such as tooth whitening or products such as implants or mouthguards. [1] [11]

The dental plan is managed by Sun Life Financial, [22] under a $747 million contract it signed with the federal government. [23] The management contract is for five years, and can be renewed for an additional five years at its expiry. [23] Its system was designed to process about 500,000 applications for program enrolment each month. [24] Once enrolled, the individual will receive a welcome package with a member card, coverage details, start date for their coverage, and information about the program. [21]

Providers may submit claims for services rendered beginning May 2024. [25] Expenses for individuals will be covered from that individual's specified start date. [21] Individuals with adjusted family net incomes of more than $70,000 but less than $80,000 will have to make a 40% copayment, and those with adjusted family net incomes exceeding $80,000 will have to make a 60% copayment. [26]

A call centre dedicated to the program will be established at Service Canada to deal with issues such as eligibility and coverage. [18]

Response

The program launched in mid-December 2023; by the end of January 2024, over 400,000 applications had been approved, [21] by 6 March over 1 million had been approved, [27] and by 11 April over 1.7 million had been approved. [16]

A survey of licensed dentists in March 2024 by the Canadian Dental Association found that 61% would not register to provide service under the Canadian Dental Care Plan. [28] The government opposed a proposal by dental associations to have patients pay dentists directly, then being reimbursed by the Canadian Dental Care Plan insurance program. [28] In April 2024, the Government of Canada eliminated the requirement for clinics and other dental care providers to register for the program, instead requiring only that "the provider agrees to direct bill Sun Life for services provided under the plan". [29]

The Canadian Dental Hygienists Association has criticized the fee structure, which reimburses dental hygienists at a lower rate than dental clinics operated by dentists. [30]

A report by economist David Macdonald stated that creating a universal service (that is, extending services to all Canadians irrespective of family income) would cost an additional $1.45 billion annually. [31] Don Davies, health critic for the NDP, stated that the NDP wants coverage expanded to universal service. [31]

Related Research Articles

<span class="mw-page-title-main">Medicaid</span> United States social health care program for families and individuals with limited resources

In the United States, Medicaid is a government program that provides health insurance for adults and children with limited income and resources. The program is partially funded and primarily managed by state governments, which also have wide latitude in determining eligibility and benefits, but the federal government sets baseline standards for state Medicaid programs and provides a significant portion of their funding.

<span class="mw-page-title-main">Medicare (United States)</span> US government health insurance program

Medicare is a federal health insurance program in the United States for people age 65 or older and younger people with disabilities, including those with end stage renal disease and amyotrophic lateral sclerosis. It was begun in 1965 under the Social Security Administration and is now administered by the Centers for Medicare and Medicaid Services (CMS).

<span class="mw-page-title-main">Medicare (Canada)</span> Canadas publicly funded, single-payer health care system

Medicare is an unofficial designation used to refer to the publicly funded single-payer healthcare system of Canada. Canada's health care system consists of 13 provincial and territorial health insurance plans, which provide universal healthcare coverage to Canadian citizens, permanent residents, and depending on the province or territory, certain temporary residents. The systems are individually administered on a provincial or territorial basis, within guidelines set by the federal government. The formal terminology for the insurance system is provided by the Canada Health Act and the health insurance legislation of the individual provinces and territories.

Medicare is the publicly funded universal health care insurance scheme in Australia, along with the Pharmaceutical Benefits Scheme (PBS) operated by the nation's social security department, Services Australia. Medicare is the principal way Australian citizens and permanent residents access most health care services in Australia. The scheme either partially or fully covers the cost of most primary health care services in the public and private health care system. All Australian citizens and permanent residents have access to fully-covered health care in public hospitals, funded by Medicare, as well as state and federal contributions. International visitors from 11 countries have subsidised access to medically necessary treatment under reciprocal agreements.

The Ontario Health Insurance Plan, commonly known by the acronym OHIP, is the government-run health insurance plan for the Canadian province of Ontario. OHIP is funded by a payroll deduction tax by residents who are gainfully employed, by businesses in the province of Ontario, and by transfer payments from the Government of Canada.

Health insurance or medical insurance is a type of insurance that covers the whole or a part of the risk of a person incurring medical expenses. As with other types of insurance, risk is shared among many individuals. By estimating the overall risk of health risk and health system expenses over the risk pool, an insurer can develop a routine finance structure, such as a monthly premium or payroll tax, to provide the money to pay for the health care benefits specified in the insurance agreement. The benefit is administered by a central organization, such as a government agency, private business, or not-for-profit entity.

The American Dental Association (ADA) is an American professional association established in 1859 which has more than 161,000 members. Based in the American Dental Association Building in the Near North Side of Chicago, the ADA is the world's largest and oldest national dental association. The organization lobbies on behalf of the American dental profession and provides dental accredation.

<span class="mw-page-title-main">Healthcare in Canada</span>

Healthcare in Canada is delivered through the provincial and territorial systems of publicly funded health care, informally called Medicare. It is guided by the provisions of the Canada Health Act of 1984, and is universal. The 2002 Royal Commission, known as the Romanow Report, revealed that Canadians consider universal access to publicly funded health services as a "fundamental value that ensures national health care insurance for everyone wherever they live in the country."

<span class="mw-page-title-main">Employee benefits</span> Non-wage compensation provided to employees in addition to normal wages or salaries

Employee benefits and benefits in kind, also called fringe benefits, perquisites, or perks, include various types of non-wage compensation provided to employees in addition to their normal wages or salaries. Instances where an employee exchanges (cash) wages for some other form of benefit is generally referred to as a "salary packaging" or "salary exchange" arrangement. In most countries, most kinds of employee benefits are taxable to at least some degree. Examples of these benefits include: housing furnished or not, with or without free utilities; group insurance ; disability income protection; retirement benefits; daycare; tuition reimbursement; sick leave; vacation ; social security; profit sharing; employer student loan contributions; conveyancing; long service leave; domestic help (servants); and other specialized benefits.

The Assured Income for the Severely Handicapped (AISH) is a provincial program established in 1979 in Alberta, Canada, that provides financial and health related benefits to eligible adult Albertans under the age of 65, who are legally identified as having severe and permanent disabilities that seriously impede the individual's ability to earn a living. The total AISH caseload was 69,785 in 2020, which represents 1.6% of Alberta's population. For those eligible for AISH, benefits include a monthly payment, as well as access to a number of services and/or subsidies, including prescriptions, dental and optical services. In 2020, the primary medical conditions of 44.1% of AISH recipients were related to physical disabilities, 30.4% were related to mental illness disorders, and 25.4% to cognitive disorders, and over 40% of AISH recipients were over fifty years of age. By 2020, the maximum AISH rate for a single person was C$1,685 per month. AISH was indexed to the Consumer Price Index in 2018, de-indexed in 2020, and is being indexed again beginning January 2023. Since 1998, there has been a C$100,000 limit on the amount of liquid assets an AISH recipient can possess. There is also a dollar for dollar claw back on any form of additional income above a set amount that an individual or a family unit receiving AISH, might earn or receive. Such offsets include federal aid, such as Canadian Emergency Response Benefit (CERB), Canada Pension Plan (CPP) disability benefits, a spouse's income, disability benefits through a private insurance plan, and/or Worker Compensation Board (WCB) benefits.

The California Medical Assistance Program is the California implementation of the federal Medicaid program serving low-income individuals, including families, seniors, persons with disabilities, children in foster care, pregnant women, and childless adults with incomes below 138% of federal poverty level. Benefits include ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder treatment, dental (Denti-Cal), vision, and long-term care and support. Medi-Cal was created in 1965 by the California Medical Assistance Program a few months after the national legislation was passed. Approximately 15.28 million people were enrolled in Medi-Cal as of September 2022, or about 40% of California's population; in most counties, more than half of eligible residents were enrolled as of 2020.

The Delta Dental Plans Association, also known as simply Delta Dental, is an American network of dental insurance companies composed of 39 independent Delta Dental members operating in all 50 states, the District of Columbia and Puerto Rico. These member companies provide coverage to 85 million people, enrolled in over 157,000 groups. While many of the Delta Dental member companies and Delta Dental Plans Association (DDPA) are non-profit organizations, a few of the member companies have for-profit segments.

<span class="mw-page-title-main">Health care in Australia</span> Availability, funding, and provision of health services in Australia

Health care in Australia operates under a shared public-private model underpinned by the Medicare system, the national single-payer funding model. State and territory governments operate public health facilities where eligible patients receive care free of charge. Primary health services, such as GP clinics, are privately owned in most situations, but attract Medicare rebates. Australian citizens, permanent residents, and some visitors and visa holders are eligible for health services under the Medicare system. Individuals are encouraged through tax surcharges to purchase health insurance to cover services offered in the private sector, and further fund health care.

<span class="mw-page-title-main">Social programs in Canada</span> Overview of social programs in Canada

Social programs in Canada include all Canadian government programs designed to give assistance to citizens outside of what the market provides. The Canadian social safety net includes a broad spectrum of programs, many of which are run by the provinces and territories. Canada also has a wide range of government transfer payments to individuals, which totaled $176.6 billion in 2009—this cost only includes social programs that administer funds to individuals; programs such as medicare and public education are additional costs.

A Health and welfare trust (HAWT) or Health and welfare plan (HAWP) is a tax-free vehicle for financing a corporation's healthcare costs for their employees. They were introduced in 1986 by Canada Revenue Agency (CRA) in their interpretation bulletin entitled IT-85R2. Many companies offer this product to Canadian employers.

In the United States, health insurance helps pay for medical expenses through privately purchased insurance, social insurance, or a social welfare program funded by the government. Synonyms for this usage include "health coverage", "health care coverage", and "health benefits". In a more technical sense, the term "health insurance" is used to describe any form of insurance providing protection against the costs of medical services. This usage includes both private insurance programs and social insurance programs such as Medicare, which pools resources and spreads the financial risk associated with major medical expenses across the entire population to protect everyone, as well as social welfare programs like Medicaid and the Children's Health Insurance Program, which both provide assistance to people who cannot afford health coverage.


Medicare Advantage is a type of health plan offered by Medicare-approved private companies that must follow rules set by Medicare. Most Medicare Advantage Plans include drug coverage. Under Part C, Medicare pays a sponsor a fixed payment. The sponsor then pays for the health care expenses of enrollees. Sponsors are allowed to vary the benefits from those provided by Medicare's Parts A and B as long as they provide the actuarial equivalent of those programs. The sponsors vary from primarily integrated health delivery systems to unions to other types of non profit charities to insurance companies. The largest sponsor is a hybrid: the non profit charity AARP using UnitedHealth.

The practice of dentistry in Canada is overseen by the National Dental Examining Board of Canada in conjunction with other agencies, such as the Commission on Dental Accreditation of Canada and the Royal College of Dentists of Canada. In 2013 there were 21,109 dentists in Canada according to the Canadian Dental Association.

Disability benefits are a form of financial assistance designed to support individuals who are unable to work due to a chronic illness, disease or injury. Disability benefits are typically provided through various sources, including government programs, group disability insurance provided by employers or associations or private insurance policies typically purchased through a licensed insurance agent or broker, or directly from an insurance company.

<span class="mw-page-title-main">44th Canadian Parliament</span> Parliamentary term of the Parliament of Canada

The 44th Canadian Parliament is the session of the Parliament of Canada which began on 22 November 2021, with the membership of the House of Commons, having been determined by the results of the 2021 federal election held on 20 September. Parliament officially resumed on 22 November with the re-election of Speaker Anthony Rota, and the Speech from the Throne read by Governor General Mary Simon the following day.

References

  1. 1 2 3 4 5 6 7 8 9 Rachini, Mouhamad (12 December 2023). "Canada's new dental care plan could impact nearly 9 million Canadians — are you one of them?". CBC News . Retrieved 31 January 2024.
  2. 1 2 3 4 Osman, Laura (29 March 2023). "Budget 2023 expands dental-care program, but expected cost balloons to $13B". Global News. Retrieved 31 January 2024.
  3. ↑ Allison, Paul J. (6 July 2023). "Canada's oral health and dental care inequalities and the Canadian Dental Care Plan". Canadian Journal of Public Health . 114 (4): 530–533. doi:10.17269/s41997-023-00800-6. PMID   37410362 . Retrieved 25 February 2024.
  4. ↑ Austin, Ian (21 September 2021). "Justin Trudeau to Remain Prime Minister of Canada". The New York Times . Retrieved 31 January 2024.
  5. ↑ Scherer, Steve; Shakil, Ismail (22 March 2022). "Canada's Trudeau strikes surprise deal to keep power until 2025". Reuters . Retrieved 31 January 2024.
  6. ↑ "Details of Canada PM Trudeau's deal with NDP to keep power until 2025". Reuters . 22 March 2022. Retrieved 31 January 2024.
  7. ↑ Aiello, Rachel (22 March 2022). "Liberals' deal with NDP will keep Trudeau minority in power for 3 more years". CTV News . Retrieved 31 January 2024.
  8. 1 2 3 Boisvert, Nick (23 March 2022). "Everything we know about the Liberal-NDP dental care proposal". CBC News. Retrieved 11 February 2024.
  9. ↑ von Stackelberg, Marina (1 February 2024). "National dental care plan registration expands today to cover seniors 72 and older". CBC News. Retrieved 24 February 2024.
  10. 1 2 Eschner, Kat (18 December 2023). "Everything we know (so far) about the Canadian Dental Care Plan". TVO . Retrieved 25 February 2024.
  11. 1 2 3 Pelley, Lauren (14 December 2023). "Seniors spend thousands on dental work, suffer in pain or wind up in ERs. Will Canada's plan help?". CBC News. Retrieved 24 February 2024.
  12. ↑ "Federal dental insurance program to be phased in starting May 2024, government officials say". CBC News. The Canadian Press. 10 December 2023. Retrieved 31 January 2024.
  13. ↑ Osman, Laura (12 December 2023). "Don't call it insurance: What dentists want you to know about the federal dental plan". CTV News. The Canadian Press . Retrieved 2 February 2024.
  14. ↑ Osman, Laura (10 November 2023). "For more info on national dental care, provincial dental groups must sign confidentiality agreements: minister". CBC News. The Canadian Press . Retrieved 24 February 2024.
  15. 1 2 3 4 5 Wilson, Jim (19 January 2024). "11.4 million uninsured Canadians to be excluded from national public dental care plan: Report". Canadian HR Reporter. KM Business Information Canada. Retrieved 2 February 2024.
  16. 1 2 von Stackleberg, Marina (11 April 2024). "'Hundreds of thousands' of seniors will get subsidized dental care next month, health minister vows". CBC News . Retrieved 11 April 2024.
  17. ↑ Yun, Tom (17 January 2024). "New dental care plan leaves out 4.4 million uninsured Canadians: report". CTV News . Retrieved 25 February 2024.
  18. 1 2 3 4 5 6 Tasker, John Paul (11 December 2023). "Ottawa launches $13B dental-care program with kids and seniors first up for coverage". CBC News. Retrieved 31 January 2024.
  19. ↑ Janes, Sadie (17 January 2024). "Tax credit could ensure national dental-care plan doesn't displace employer-sponsored coverage: expert". Benefits Canada. Contex Group. Retrieved 2 February 2024.
  20. ↑ "The Canadian Dental Care Plan (CDCP): Impact on 2023 tax form reporting". Manulife Financial. 14 November 2023. Retrieved 25 February 2024.
  21. 1 2 3 4 "More than 400,000 Canadian seniors have been approved for dental care under the Canadian Dental Care Plan" (Press release). Employment and Social Development Canada. 31 January 2024. Retrieved 24 February 2024.
  22. ↑ Law, Jaclyn (22 December 2023). "The new CDCP: Here's when seniors can apply for the federal government's dental plan". MoneySense . Retrieved 31 January 2024.
  23. 1 2 Bickis, Ian (8 February 2024). "Sun Life CEO optimistic on Canadian dental plan potential". Cochrane Eagle . The Canadian Press . Retrieved 24 February 2024.
  24. ↑ Osman, Laura (1 February 2024). "Ottawa's planned rollout of dental care will miss deadline". Montreal Gazette . The Canadian Press . Retrieved 2 February 2024.
  25. ↑ "Dentists, hygienists still in the dark on details of federal dental-care plan". Winnipeg Free Press . The Canadian Press. 31 January 2024. Retrieved 31 January 2024.
  26. ↑ Dangerfield, Katie (11 December 2023). "Federal dental insurance plan details unveiled. What to know". Global News . Retrieved 31 January 2024.
  27. ↑ Previl, Sean (6 March 2024). "Can you apply for Canada's dental plan? Eligibility rules get update". Global News . Retrieved 10 March 2024.
  28. 1 2 Saba, Michael (9 April 2024). "Dental associations are 'negotiating' ahead of federal dental plan rollout, heath minister says". The Globe and Mail . The Canadian Press . Retrieved 11 April 2023.
  29. ↑ Lopez Steven, Benjamin (17 April 2024). "Dentists can bill for federal dental plan patients without signing up for program, government says". CBC News . Retrieved 18 April 2024.
  30. ↑ "Hygienists ask for equal pay under federal dental-care plan". Montreal Gazette . The Canadian Press. 15 April 2024. Retrieved 18 April 2024.
  31. 1 2 Osman, Laura (17 January 2024). "Federal dental care program will exclude 4.4M uninsured Canadians: report". CBC News. The Canadian Press . Retrieved 24 February 2024.

Further reading

This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.