The national dental care program has “transformed access to care for millions of patients” but claims are being denied without explanations and too many people are confused about what’s covered, says a new report from the Canadian Dental Association.
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report → transform → Association
The association commissioned the report to assess the dental care program’s progress and make recommendations to the federal government on how it can be improved.
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it → commission → government
“We have a strong program, it’s got a good foundation, but continuous improvement is essential if the program is ever going to reach its potential,” said Dr. Kirk Preston, president of the Canadian Dental Association.
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Preston → have → Association
The program, which launched in 2022, was created as part of the supply-and-confidence agreement between the NDP and Justin Trudeau’s minority Liberal government.
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which → launch → NDP
The first phase offered coverage for seniors before the program was expanded to include adults with disabilities and children.
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program → offer → disabilities
The final expansion, which was announced the day before Prime Minister Mark Carney called the 2025 election, opened coverage to all adults with a household income under $90,000 who do not have private insurance.
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who → announce → insurance
It’s been billed as the largest single expansion in public health care in decades, with an estimated nine million people eligible.
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people → bill → decades
Around 6.5 million have signed on to the program so far.
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million → sign → program
Colloquially, politicians have referred to the dental care program as free dental care – something that has created lasting confusion.
“I had a patient just last week that came in and he said, ‘I thought it was free,’” Preston said.
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Preston → refer → patient
The program provides different levels of coverage depending on income.
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program → provide → income
Those in the highest income bracket must cover 60 per cent of their fees.
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Those → cover → fees
Coverage is also based on set fees for services the CDA said are often below the cost of treatment.
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CDA → base → treatment
That leaves many patients with unexpected bills, the report says.
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report → leave → bills
Ondina Love, CEO of the Canadian Dental Hygienists Association, said confusion over what the plan covers has added to the administrative burdens on clinics.
“We are recommending enhanced public education and clear communications regarding what’s covered,” she said.
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she → say → education
Preston said dentists’ biggest concerns are about pre-authorization.
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concerns → say → authorization
Clinics need to submit treatment plans ahead of time for things like root canals, specialist services, or care above what the dental care plan typically covers.
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plan → need → what
The insurance provider, Sun Life, determines if the care will be covered.
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care → determine → ?
Those claims are denied half the time, the report said.
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report → deny → ?
“It’s frustrating for dentists and patients because there’s no clear explanation in most cases as to why the claims are not approved,” Preston said.
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Preston → ’ → cases
The report said denials can lead to a manageable condition getting worse, forcing patients into more invasive and expensive care.
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condition → say → care
“It’s not consistent and I don’t understand what their guidelines are for approving or denying treatment in the pre-authorization process,” Preston said.
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Preston → ’ → process
The CDA report calls for better education for care providers, more transparency and clear clinical criteria for pre-authorizations.
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report → call → authorizations
It also calls for fee increases to keep up with rising costs in dental clinics, along with better work force planning to address shortages of dental hygienists and assistants.
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It → call → hygienists
Love said that last point is critical.
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point → say → ?
“We do know that in certain regions, there’s a sufficient supply – maybe even oversupply – and in other regions, there definitely is a shortage,” she said.
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she → know → regions
The report noted that patients, especially seniors, have reported difficulties with reapplying for coverage each year.
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patients → note → coverage
The income criteria can mean patients who had care one year might lose it the next.
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who → mean → it
Overall, patients report a high level of satisfaction with the program.
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patients → report → program
The report includes surveys of both patients and dentists, commissioned by the CDA and carried out by Abacus Data.
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report → include → Data
More than half of the patients surveyed said they’ve been able to free up savings to spend on groceries and other essentials.
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they → survey → groceries
“This is a notable achievement for a program of such scale and ambition,” it said.
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it → say → scale
In early 2024, nearly 70 per cent of dentists told the CDA they were opposed to the program.
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they → tell → program
Its initial phases required providers to opt in, and uptake was so slow that government eliminated that requirement.
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government → require → requirement
The new report says over 90 per cent of dentists are taking part in the program, and 70 per cent are supportive.
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cent → say → program
The CDA recommends the federal government commission an independent evaluation of the program’s effectiveness, and use that to decide whether it’s reaching the intended patients.
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it → recommend → patients
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