With the rollout of the Canadian Dental Care Plan (CDCP), many Surrey residents are asking: “Should I cancel my private dental insurance?” or “How is the CDCP different from the benefits I get through my employer?”

Understanding the key differences between government-funded care and private insurance is critical to making the best financial decisions for your family’s oral health. Here is a comparison from the team at Canary Dental.

1. Eligibility Criteria

Private Insurance: Eligibility is typically tied to your employment. If you are a full-time employee, your company may pay the premiums for a group dental plan. Alternatively, you can purchase individual private insurance directly from providers like Pacific Blue Cross, regardless of your income.

CDCP: Eligibility is strictly based on income and lack of existing coverage. You are only eligible if your adjusted family net income is under $90,000, you are a Canadian resident for tax purposes, and you do not have access to any other dental insurance (including employer-sponsored plans, even if you opt out of them).

Important note: You cannot use the CDCP to “top up” your private insurance.

2. Co-Payments and Fee Guides

Private Insurance: Private plans reimburse dentists based on the current Provincial Dental Association Fee Guide. If your plan covers 80% for a dental cleaning, they pay 80% of that standard provincial fee, and you pay the remaining 20%.

CDCP: The government has created its own specific CDCP Fee Guide, which is often slightly lower than the standard provincial fee guide. Furthermore, depending on your income, the CDCP might only cover 40%, 60%, or 100% of that lower CDCP fee.

This means that even if you qualify for “100% CDCP coverage,” you might still have a small out-of-pocket balance to pay to the clinic if there is a gap between the CDCP fee and the clinic’s standard fee. At Canary Dental, we always perform a pre-determination so you know exactly what your costs will be before we start.

3. Pre-Authorizations and Treatment Limits

Private Insurance: While major treatments (like crowns or dental implants) usually require a pre-determination, routine care like cleanings and fillings are generally approved instantly without extensive paperwork.

CDCP: The CDCP has much stricter guidelines. Many moderate-to-complex treatments (such as root canals, partial dentures, and deep scaling for gum disease) require heavy documentation and pre-authorization from Sun Life. Some treatments, like purely cosmetic dentistry, are completely excluded from the CDCP but might have partial coverage under some premium private plans.

Summary: Which is Better?

If you have access to a good private or employer-sponsored dental plan, you should keep it. It generally offers more comprehensive coverage with fewer restrictions.

However, if you do not have insurance and meet the income requirements, the CDCP is an incredible lifeline that can help you maintain a healthy smile without the burden of massive out-of-pocket costs.

If you have questions about your specific coverage, reach out to our team via LINE or visit our CDCP Surrey Dentist page.

---

Disclaimer: The content provided on this blog is for informational and educational purposes only and is not intended as a substitute for professional medical or dental advice, diagnosis, or treatment. Coverage details are based on current government information and may be subject to change. Always seek the advice of your dentist or other qualified healthcare provider with any questions you may have regarding a dental condition.