CDCP or private insurance: what actually differs

The CDCP is not a second insurance policy that tops up the one you have. It exists for people who have no private dental coverage at all, and it works differently from a workplace plan in ways that show up on your bill.

Can I have the CDCP and a private plan?

No. Having access to private dental insurance disqualifies you, and access is the test, not use. Coverage through a job, a pension, a professional or student association, or a policy you bought yourself all count — even if you have never made a claim or chose not to enrol.

There is one exception: retirees who opted out of pension dental coverage before 11 December 2023 and cannot opt back in.

What if my situation changes mid-year?

If you gain access to private coverage, you stop being eligible, and you are expected to tell Service Canada rather than wait for the next renewal. Coverage from a government programme is different — Healthy Smiles Ontario, Ontario Works and ODSP do not disqualify you, because those plans coordinate with the CDCP.

Who decides what a treatment costs?

This is the difference that surprises people. The CDCP pays a percentage of its own fee schedule, which is set federally and can sit below what a practice charges. A private plan usually pays a percentage of the fee actually billed, up to an annual maximum.

So under the CDCP, two things can add to your bill: your income-based co-payment, and the gap between the plan’s fee and ours. Service Canada puts it plainly — you may pay more if the cost of your care is above what the plan reimburses.

Then why does the plan still help?

Because for most everyday care it covers a large share of a bill that would otherwise be yours in full: exams, X-rays, cleanings and scaling, fillings, root canal treatment, gum care, extractions, and complete dentures. For a household under $70,000 there is no co-payment at all on the plan’s fees.

What does a private plan do that the CDCP does not?

Workplace plans vary far too much to summarise honestly, but two differences hold generally: they rarely require the insurer’s approval before routine work, and they usually pay against the billed fee rather than a separate schedule. The CDCP asks for pre-approval on a defined list of treatments — crowns and partial dentures among them.

How do we handle it here?

We bill Sun Life directly, so you are not paying up front and waiting for money back — the plan reimburses providers, never patients. Whichever way you are covered, you get the estimate in writing first: what the plan pays, what you pay, and what is not covered at all.

Who qualifies and what the co-payment bands are is set out on our CDCP guide, and coverage has to be renewed every year — see renewing your CDCP coverage.

Source: Government of Canada — What is covered.