When the Canadian Dental Care Plan debuted in May, Maneesh Jain – a Guelph, Ont., dentist and president of the Ontario Dental Association – refused to sign up.
In order to see patients who would be covered under the new program, dentists such as Dr. Jain had to sign a contract that included clauses allowing plan administrative staff to conduct audits of dental offices’ books.
“No other insurance company has ever required us to do that,” Dr. Jain said.
He wasn’t alone in pushing back, and in the early going the federal government struggled to convince oral health care providers to sign up.
So Ottawa listened and changed tack. In July, Health Minister Mark Holland announced that dentists would no longer have to sign a contract and could just submit claims to the public insurance plan as they do with private ones.
It’s part of an evolution of the program, which continues to go through changes, with more coming in November and into next year. Ottawa is slowly expanding access to more Canadians, but in doing so must win over the health professionals who are providing the care.
The Liberal minority government pledged to create a public dental care insurance plan in 2022 as part of its now-cancelled supply-and-confidence agreement with the NDP. The goal of the program was to fill gaps in coverage by providing a public plan for seniors, children and other Canadians without private dental benefits. It is means-tested and only available to families making less than $90,000 a year.
In 2023, the government opened a competitive bidding process and ultimately awarded Sun Life Financial Inc., one of Canada’s largest private health insurers, a six-year, $747-million contract to administer the plan. (Sun Life declined to comment, referring questions to Health Canada.) Ottawa has budgeted a total of $13-billion over five years to pay for the program, starting in the 2023-24 fiscal year.
Eligibility opened in waves in 2024, first for seniors in different age brackets, then adults with valid Disability Tax Credit certificates and children. All other Canadians who qualify will be able to sign up next year.
As of Sept. 19, a little fewer than 2.5 million Canadians had signed up for the plan and 751,000 had had a claim covered. About 21,000 dental professionals, including dentists, denturists and hygienists, had signed up – some three-quarters of providers.
Further changes for professionals are coming in November. That’s when dentists will be able to bill for services that require preauthorization, which tend to be longer and more complicated procedures.
Aaron Burry, the chief executive officer of the Canadian Dental Association, said this will be significant because patients who have gone a long time without seeing a dentist – in other words, the kind of patients the plan is designed to reach – are more likely to have serious needs.
Another change coming next month is that Sun Life will start accepting paper claims. Sylvie Martel, the director of dental hygiene practice at the Canadian Dental Hygienists Association, said that will help many hygienists who operate mobile clinics and find physical paperwork easier to file. Those professionals also tend to reach patients and communities that would benefit from the public plan, she said.
One of the biggest early concerns from dentists was the fees that would be reimbursed under the federal plan. Each province’s dental association releases an annual guide of suggested fees, which private plans tend to use to set reimbursement rates, but provincial public plans usually only reimburse a fraction of those fees.
Brandon Doucet, a Newfoundland dentist and chair of the Coalition for Dentalcare, said many dentists have traditionally considered providing care under provincial plans a money-losing operation, because they often reimburse less than half of the suggested fees. But the federal program is more generous, he said, pointing to Nova Scotia, where dentists are reimbursed, on average, 88 per cent of the suggested fees.
Independent dental hygienists, though, are paid 15 per cent less than a dentist’s office for the same services, Ms. Martel said, and her association has been pushing for parity. She said the Health Minister’s office has expressed openness to changing that policy in the coming weeks.
Matthew Kronberg, a spokesperson for Mr. Holland, said Ottawa is listening to professionals’ concerns and “made changes to our approach so that the program works well for the patients that get care and for the providers who make it possible.”
The government is now on a promotional blitz, with advertising buys on social media, television and streaming services, to increase awareness of the federal plan – although, dentists say, patients have been more likely to bring questions to them than try to get answers from the government.
That’s been a challenge at times, Dr. Burry said – one he hopes gets easier as Canadians learn more about the program. Unlike public primary care, dental care is not totally free and features co-pays that can change depending on income levels and other reasons. “That’s time-consuming because it’s a complicated program to explain,” he said.
