Ottawa launches $13B dental-care program with kids and seniors first up for coverage

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, with other age groups able to apply sometime in the new year.

The staggered application process is designed to make the rollout as smooth as possible, with the government anticipating hundreds of thousands of people will avail themselves of this new component of the country’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.

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.

However, 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.

To be eligible for the program, a person must have a household income below $90,000 and not have 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 those families that have a household income below $70,000, as there will be no co-pays payable to a participating dentist, hygienist or denturist — Ottawa will pick up the tab for covered services like cleaning, polishing, examinations, X-rays, fillings and root canal treatments.

Families with an income between $70,000 and $79,999 will face a 40 per cent co-pay, and for those that fall into 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.

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.