Canadian Dental Care Plan or Private Dental Insurance?
How to Tell Which One You Should Have

1 Start With the Government Plan, Not With Us

Most guides to dental insurance written by brokers begin by explaining why you need to buy a policy. This one begins the other way around, because for a large number of Canadian households the honest answer is that the federal plan is the better deal and a private policy would be a mistake.

The Canadian Dental Care Plan is a federal program that pays a share of routine oral health care for households that have no access to dental coverage and earn under a set income ceiling. It is not a subsidy that tops up an existing plan. It is an either-or: you qualify only if you have no dental coverage at all.

2 The Four Requirements, and All Four Must Be Met

According to the eligibility rules on canada.ca, you must meet every one of these:

1. No access to private dental insurance or coverage. The detail that catches people out, explained in the next section.
2. You filed your Canadian tax return for the previous year, and so did your spouse or common-law partner if you have one.
3. Your adjusted family net income is under $90,000. Not your gross salary, a specific calculation shown below.
4. You are a Canadian resident for tax purposes, as is your spouse or partner.

Requirement two is worth pausing on if you have recently arrived in Canada. Until you have filed a Canadian tax return, you cannot qualify, no matter how low your income is. Newcomers in their first year are in exactly that position, which is one of the situations covered in our provincial health waiting period guide.

3 Why "Access" Is Broader Than "Having"

The first requirement is not about whether you use dental coverage. It is about whether you have access to it. The government treats you as having access if coverage exists through any of these:

• your work or pension plan
• a family member's work or pension plan
• a professional or student organization
• any policy bought by you or a family member, including top-up or supplementary dental coverage

And you are still counted as having access, and therefore not eligible, even if:

• you have never used it
• you chose not to enrol in it
• you pay a premium for it
• it does not cover the full cost of your care
• you opted out of pension dental coverage after December 11, 2023

One thing that does not disqualify you: coverage through a provincial, territorial or federal government social program. Those plans coordinate with the CDCP rather than cancelling your eligibility.

4 The Two Minute Check That Settles It

You do not have to guess whether your household has access. It is printed on your tax slips.

Check your spouse or partner's slips as well, because their workplace plan can give your whole family access and disqualify all of you. If you apply while your slip shows access, you can be asked to prove that the coverage has ended, and if the proof does not hold up you can be removed from the plan and asked to repay what it spent on your care.

5 Working Out Your Adjusted Family Net Income

The $90,000 ceiling is not your salary. It is adjusted family net income, and it is calculated from your tax return:

For most households with no UCCB or RDSP amounts, the figure is simply line 23600, combined for both partners. If you are close to the line, it is worth doing the arithmetic properly rather than assuming.

6 What the Plan Actually Pays

Below $70,000 of adjusted family net income, the CDCP covers the full established fee for eligible services. Above that, you pay a share:

The full list of covered services and the preauthorization rules are set out on the coverage page on canada.ca.

7 Three Households, Three Different Answers

The rules only become clear against real situations. Three households, all in Toronto, all asking the same question:

The middle case is the one people get wrong most often. A spouse's modest workplace plan disqualifies the entire household from the CDCP, including a partner who is not on it and children it barely covers. That is not a loophole to work around, since dropping the coverage after December 11, 2023 does not restore eligibility, but it does change the question from which plan to is the existing plan enough.

Notice also that in the first case the correct advice from a broker is to buy nothing at all. That will not be the right answer for everyone reading this, but it is the right answer often enough that it should be the first thing checked.

8 Who the Plan Cannot Help

Private dental insurance exists for the households the CDCP leaves out, and there are more of them than people expect:

• Households at or above $90,000 of adjusted family net income, however modest that feels with a mortgage and children in a city like Toronto.
• Anyone with workplace or pension dental coverage, including coverage that is thin, capped low, or only covers part of a family. You cannot drop it to qualify, and dropping it after December 11, 2023 does not help.
• Recent arrivals who have not yet filed a Canadian tax return. Eligibility depends on assessed income, so the first filing year is a gap.
• Visitors, and people here temporarily who are not Canadian residents for tax purposes.
• Self-employed people above the income line, who have neither a workplace plan nor the federal plan to fall back on.

If you are in one of those groups, private dental coverage does the job the CDCP would otherwise do: routine cleanings and exams, fillings, and a share of major work. For a small business owner covering a team rather than a household, that is a group plan instead, which our group benefits guide covers.

9 If You Do Need Private Dental, Compare These Four Things

Private dental plans look similar on a price list and behave very differently at the dentist. Four terms decide almost everything, and none of them is the monthly premium:

• The annual maximum. The ceiling the plan pays per person per year. A low maximum is what turns a plan that looked affordable into one that runs out in the same visit that a crown is fitted.
• The waiting period before major work. Cleanings and exams usually start quickly, while crowns, bridges and dentures commonly sit behind a waiting period. Buying a plan the month before major treatment rarely works, and insurers design it that way on purpose.
• The coinsurance tiers. Most plans pay a high share of preventive care, a lower share of basic work such as fillings, and lower again for major work. Two plans quoting the same premium can pay very differently once you go beyond a cleaning.
• What counts as pre-existing. Treatment already recommended or underway is often excluded, so a plan bought after a diagnosis may not cover the thing that prompted the purchase.

A useful way to test any quote is to price a realistic year rather than a perfect one: two cleanings and exams, one filling, and a share of one larger item. If the annual maximum cannot absorb that, the premium is not the number that matters.

10 What to Do Before You Buy Any Dental Policy

1. Check box 45 on every T4 in the household. Two minutes, and it decides everything else.
2. Work out your adjusted family net income from line 23600 rather than guessing from your salary.
3. If you qualify, apply for the CDCP through the application process on canada.ca and buy nothing privately. A private policy would end your eligibility.
4. If you do not qualify, compare private plans on the terms that matter: the annual maximum, the waiting period before major work is covered, and what share of major services is paid, not just the monthly premium.
5. Reconfirm every year. CDCP eligibility is reviewed annually, and if someone in the household starts a job with benefits, that changes your status.

11 If You Want Help Working Out Whether You Qualify

The four requirements are simple to read and easy to get wrong, particularly when two spouses have different tax slips, when income sits near the ceiling, or when the forms are not in your first language. If you would rather not work it out alone, call and a licensed advisor will go through it with you.

• We will read the codes with you. Box 45 on each T4, box 015 on any T4A, including your spouse's, since their plan can disqualify the household.
• We will work out adjusted family net income from the right lines of your return rather than from your salary.
• We will tell you plainly which side of the line you are on, and if the federal plan covers you, that is the advice, and there is nothing to buy.
• In your language. English, Ukrainian, Russian, Turkish, Spanish, Mandarin, Cantonese and Pidgin.

There is no charge for this and no obligation attached to it.

12 The Short Version

A broker who tells you to buy dental insurance without first asking about box 45 and your family net income is not doing the job properly. For a household under $90,000 with no access to coverage, the federal plan pays more than a private policy would and costs nothing in premiums, and buying private coverage would take that away.

For everyone else, private dental is genuinely useful, and worth comparing on annual maximums and waiting periods rather than headline price. Knowing which group you are in takes about five minutes, and it is the only part of this that really matters.

13 Frequently Asked Questions