What Does the CDCP Cover in 2026? (And What You'll Still Pay)

What does the CDCP cover in 2026?

The Canadian Dental Care Plan is a federal program administered through Sun Life. It covers a defined list of services at fees the plan sets itself, for residents with an adjusted family net income under $90,000 and no access to private dental insurance. The rules below come from the CDCP Dental Benefits Guide that took effect April 1, 2026.

The plan splits services into two groups. Routine care such as check-ups, cleanings, fillings and most root canals is covered automatically, within frequency limits. Bigger-ticket items such as crowns, partial dentures and deeper sedation are only covered if Sun Life approves them before treatment starts. That approval step is called preauthorization, and it matters enough that we've given it its own section below.

What's not covered at all?

The plan keeps a hard exclusion list. These services can't be covered even with preauthorization, and for implants the guide states they aren't eligible for reconsideration either. If you need one of these, you're paying the full fee yourself or through other insurance.

Orthodontics sits in its own odd spot. The 2026 guide includes a section for orthodontic services, but that section reads, in full, that they're currently not available. So braces and clear aligners such as Invisalign are not covered in 2026, and no start date has been published. If your teen needs orthodontic work, plan on paying privately for now.

Excluded outright under the CDCP:

• Dental implants and every implant-related procedure, including implant-supported crowns and dentures
• Teeth whitening and any other cosmetic treatment
• Veneers
• Bridges (the guide excludes all fixed prosthodontics)
• Inlays and onlays
• Night guards and sports mouth guards
• Bone grafts, crown lengthening, and TMJ (jaw joint) appliances

What does "covered" actually mean?

Here's the part that surprises people. The CDCP pays a percentage of its own established fees, not a percentage of your dentist's actual bill. Every dental office sets its own fees, and in Ontario most offices work from the Ontario Dental Association's suggested fee guide. The CDCP's fee for the same procedure is often lower. Whatever the difference is, it lands on you, on top of any co-payment.

Health Canada's own factsheet shows how this plays out. In their example, a dentist charges $145 for two units of scaling (a 30-minute cleaning). The CDCP established fee for that service is $134. Even Jane, whose income is $32,000 and who has no co-payment at all, still pays $11 out of pocket. The Canadian Dental Association says the same thing plainly on its patient page: many CDCP fees don't meet the full cost of treatment in a dental office.

One more rule worth knowing before your first visit: Sun Life only reimburses dental providers, never patients. If you pay the full bill yourself planning to claim it back later, you won't get that money back. Confirm the office bills Sun Life directly before you sit in the chair.

How do the co-payment tiers work?

Your co-payment is a fixed percentage of the CDCP fee, set by your adjusted family net income from last year's tax return. Under $70,000, the plan pays 100% of the CDCP fee and your co-payment is zero. From $70,000 to $79,999, the plan pays 60% and you pay 40%. From $80,000 to $89,999, the plan pays 40% and you pay 60%. At $90,000 or above, you don't qualify for the plan at all.

Here's Health Canada's worked example at the 40% tier. Hakeem and his spouse have an adjusted family net income of $76,000. His dentist charges $145 for a two-unit cleaning, and the CDCP fee is $134. The plan pays the office 60% of $134, which is $80.40. Hakeem pays his 40% co-payment of $53.60, plus the $11 difference between the office fee and the CDCP fee. His total at the desk: $64.60 on a $145 cleaning.

At the 60% tier the same visit costs more. Kate's family income is $82,000, so she pays $80.40 (60% of $134) plus the same $11 gap, for a total of $91.40. Notice the pattern in both cases: the co-payment applies to the CDCP fee, and the fee gap gets added on top. On a small cleaning bill that's manageable. On a crown or a denture, the same math applies to much bigger numbers, so ask for the estimate first.

How does preauthorization work?

Preauthorization means Sun Life reviews the treatment before you get it and decides whether the plan will pay. Your dental office submits the request for you, with supporting evidence: a treatment plan, x-rays taken within the last 12 months, and for crowns a complete gum-measurement chart as well. You can't submit it yourself.

The approval has to come through before treatment starts. Work done first and submitted after generally won't be paid, apart from a narrow emergency exception the plan calls post-determination. Approvals aren't automatic, either. Crowns have strict clinical criteria: the tooth must be extensively broken down, the gums around it must be healthy, and a crown requested mainly to improve how a tooth looks will be refused. If a request is denied, your dentist can ask for reconsideration, or you can go ahead with treatment and pay privately.

Once granted, most approvals stay valid for up to 12 months, and some preventive and gum treatments for up to 24 months, as long as your coverage is still active on the day of treatment. Expect some waiting between the request and the decision, and build that into your treatment timeline. Your dental office can tell you what turnaround they've been seeing.

How do you avoid a surprise bill?

Before any treatment beyond a basic check-up, ask the office to send an estimate to Sun Life. The estimate confirms your coverage is active, which services the plan will cover, and how much it will pay. It's the closest thing to seeing the bill before you commit.

Then ask two direct questions: does this office bill Sun Life directly, and what will I owe beyond what the plan pays? Get the answer in dollars, not percentages. Also check that your coverage is active before every appointment, because treatment is paid at the plan rules and fees in effect on the day of service, not the day of the estimate.

Do you need to renew every year?

Yes. CDCP coverage runs by benefit year, and you must renew annually and confirm you still qualify, including that you have no access to private dental insurance. Miss the renewal window and any dental work you get during the gap won't be covered or reimbursed, even if you re-enrol later.

Service Canada checks those declarations. Employers report dental-benefit access in box 45 of your T4 (box 015 on a T4A for pensions), and if your slip shows access you didn't declare, you can be removed from the plan and required to repay what it spent on your care. If your work situation changes mid-year, sort out what it means for your eligibility before booking more treatment.

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