Dental Articles - London

The Canadian Dental Care Plan (CDCP) is a new federal program designed to help millions of Canadians access dental care. While it is a positive step forward, it’s important to understand how it works and what it means for your visits to MEK Dental in London.

How the CDCP Works

The CDCP is a government-funded benefit, not a free dental program. It is administered by Sun Life and helps cover dental costs for eligible Canadian residents who do not have private dental insurance and have an adjusted family net income of less than $90,000.

Key Differences: The CDCP Fee Guide vs. the ODA Fee Guide

It’s important for our patients to know that the CDCP uses its own national fee guide, which differs from the Ontario Dental Association (ODA) fee guide—the standard pricing guide used by most dental offices in Ontario, including ours.

• CDCP Fees: These fees are set by the federal government and Sun Life and are generally lower than the market rates for dental services in Ontario.
• ODA Fees: The ODA fee guide is updated annually to reflect the costs of providing high-quality dental care, including staff wages, advanced technology, lab fees, and clinic overhead.

Why This Matters for Your Out-of-Pocket Costs

Because MEK Dental’s fees are based on the ODA guide, there may be a difference between what we charge and what the CDCP covers. This difference is called “balance billing” and is the patient’s responsibility to pay.

Here’s an example using a patient with an adjusted family net income of $75,000 (meaning they have a 40% co-payment):

Service	MEK Dental Fee (based on ODA guide)	CDCP Max Coverage (60%)	Patient’s Out-of-Pocket Portion
Crown	$1,200	$480	$720

Breakdown of Patient’s Cost:

• Co-payment (40% of CDCP fee): $320
• Balance Billing (difference between ODA and CDCP fees): $400
• Total: $720

In this scenario, while the CDCP provides significant assistance, you would still be responsible for the remaining $720, which is a combination of the co-payment and balance billing.

Important Points for CDCP Patients

• Request a Pre-Treatment Estimate: To avoid surprises, ask our team for a detailed pre-treatment estimate. This document will show the total cost, the portion covered by the CDCP, and the amount you are responsible for.
• Understand Co-Payments: Your co-payment depends on your family’s adjusted net income:
  • Under $70,000: No co-payment (CDCP covers 100%).
  • $70,000–$79,999: 40% co-payment (you pay 40% of the CDCP fee; the plan covers 60%).
  • $80,000–$89,999: 60% co-payment (you pay 60% of the CDCP fee; the plan covers 40%).
• Pre-Authorization for Major Procedures: For certain major services such as crowns, bridges, and dentures, the CDCP requires pre-authorization from Sun Life before treatment begins. This confirms coverage based on the plan’s clinical criteria. Our team will handle this for you.
• Balance Billing is Permitted: The CDCP allows dentists to balance bill patients. This means we can charge our standard ODA fee, and you are responsible for any amount not covered by the plan, including co-payment and the difference between fee guides.
• No Upfront Payment for Covered Portion: When we bill Sun Life directly, you only pay your out-of-pocket share.

The Bottom Line

The Canadian Dental Care Plan is a valuable new benefit that can make dental care more accessible. However, it is not intended to cover all costs. By understanding the differences between the CDCP and ODA fee guides and requesting a pre-treatment estimate, you can make informed decisions and avoid unexpected expenses.

If you have questions about your CDCP coverage or would like to schedule an appointment, contact our team at MEK Dental in London.

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Dentist London