The following article is a patient resource to make understanding coordination of benefits easier for patients. Patients should review with their dental practice to confirm their personal coverage and that coordination of benefits guidelines have not been updated.
You can qualify for the Canadian Dental Care Plan (CDCP) while receiving dental benefits through a provincial, territorial or federal government social program. You must still meet the CDCP's other eligibility requirements.
But being eligible for two programs does not necessarily mean both will pay for the same treatment. Program guidelines determine which one is the first payer, whether another can contribute, and what you may have to pay out of pocket.
Find your program
Provinces: Alberta · British Columbia · Manitoba · New Brunswick · Newfoundland and Labrador · Nova Scotia · Ontario · Prince Edward Island · Quebec · Saskatchewan
Territories: Northwest Territories · Nunavut · Yukon
Federal programs: Non-Insured Health Benefits (NIHB) · Veterans Affairs Canada (VAC) · Interim Federal Health Program (IFHP)
Can I qualify for the CDCP if I already have government-subsidized dental coverage?
Government social dental benefits do not automatically disqualify you. The CDCP requires:
- No access to private dental insurance or coverage.
- An adjusted family net income below $90,000.
- Canadian tax returns filed for the previous year by you and your spouse or common-law partner, if applicable.
- Canadian residency for tax purposes for you and your spouse or common-law partner, if applicable.
Government social benefits are different from private insurance
Private coverage includes dental benefits available to you through employment, a pension, a professional or student organization, a plan purchased by you or a family member, or a health spending account. Access still counts if you have not enrolled or used the benefits. A government employee's workplace plan is not the same as a government social program.
Pension exception: You may qualify if you retired, opted out of pension dental coverage before December 11, 2023, and cannot opt back in. Check the full eligibility rules before applying.
An insurance company's logo does not tell you which type of coverage you have
Insurers also often administer government programs. For example, Pacific Blue Cross processes claims for the BC programs listed below, and Accerta administers Healthy Smiles Ontario and ODSP dental benefits. Confirm the program name and how you qualified for it, rather than relying on the logo or whether you pay a premium.
What does coordination of benefits mean?
Coordination of benefits is the process programs and insurance providers use to determine their respective payments for eligible dental care without duplicating benefits. The primary payer is billed first. A secondary payer considers an additional payment under its own rules; it does not automatically pay the rest of the bill.
Where a provincial or territorial program coordinates after the CDCP, the process generally follows three steps:
- The dental office bills the CDCP through Sun Life. Sun Life issues an Explanation of Benefits, a statement showing the claim assessment and payment.
- The office submits the remaining claim to the other program. That program applies its own coverage and fee limits.
- The office identifies any amount you can be charged. This depends on both the clinic's regular fee for the service and the programs' patient-billing rules.
This is not a universal billing order. Some programs pay before the CDCP, some do not combine payments, and some use a patient reimbursement process. Check your program's section below or on the official website for the most up-to-date information.
What might I still have to pay?
Having two programs does not guarantee a zero-dollar bill. Three different costs may matter:
A CDCP co-payment: The share of the CDCP-established fee that the CDCP does not pay, based on your adjusted family net income.
A fee difference: The difference between the dental office's regular fee for the service and the amount a program recognizes for that service. A program's fee schedule is its list of recognized service fees. Dental clinics often follow their provincial fee guide pricing, which can be higher than the program's fee schedule.
Care that is not covered: A service, or portion of a service, that does not meet the applicable program's coverage rules.
| Adjusted family net income | CDCP coverage up to |
|---|---|
| Below $70,000 | 100% |
| $70,000 to $79,999 | 60% |
| $80,000 to $89,999 | 40% |
These percentages apply to CDCP-established fees, not necessarily the dental office's full charge. A 0% co-payment does not guarantee that every service is free. Another government program may help with some costs, subject to its rules.
Good to know
An unpaid balance is not automatically an amount you owe.
Some programs prohibit the dental office from charging you certain remaining fee differences. This is called a restriction on balance billing.
Ask the office two questions: what will each program pay, and what is it permitted to charge me?
Does the CDCP reimburse patients?
No. For CDCP-covered care, the dental office bills Sun Life directly. You should not pay the full charge expecting Sun Life to reimburse you. A separate government program may have a reimbursement process for your remaining costs.
Do two programs mean twice the treatments or one shared approval?
No automatic doubling applies. A frequency limit sets how often, or how many units of, a service a program covers. Each program's own limits still matter; they do not simply add together.
Preauthorization means approval for coverage before treatment. When the CDCP requires it, the office must obtain CDCP approval even if another program has already approved the care. The other program may also require its own approval. Some services beyond standard CDCP limits can be considered through preauthorization, but approval is not guaranteed.
How the CDCP works with other federal dental programs
NIHB, VAC dental benefits and the IFHP are billed before the CDCP. If you qualify for both, a service covered by the CDCP but not by the other federal program may be submitted to the CDCP for payment. Do not assume that having both creates an additional allowance or covers every remaining charge.
Non-Insured Health Benefits (NIHB)
NIHB provides dental benefits to eligible First Nations and Inuit. When you also have the CDCP, NIHB is billed first.
NIHB has its own coverage and prior-approval requirements. Its dental benefits do not have deductibles or co-payments, but that does not make every proposed service eligible. Confirm coverage and any potential charges with the office before treatment.
Veterans Affairs Canada (VAC) dental benefits
If you receive VAC dental benefits and also qualify for the CDCP, VAC is billed first. VAC assesses dental coverage individually and requires approval for certain services. A VAC approval does not replace a required CDCP approval when a claim will also be made under the CDCP.
Interim Federal Health Program (IFHP)
The IFHP provides limited, temporary coverage to eligible refugees, asylum claimants and certain other groups. Its policy permits coordination when someone is eligible for both the IFHP and the CDCP, with the IFHP billed first. IFHP eligibility alone does not establish CDCP eligibility.
Important cost rule: Since May 1, 2026, the IFHP requires a co-payment of 30% of the cost it recognizes for eligible supplemental benefits, including urgent dental care. This is an IFHP charge, separate from the CDCP's income-based co-payment rules. Ask the office whether the CDCP can contribute to your specific treatment; do not assume it will reimburse the IFHP co-payment.
How the CDCP works with provincial and territorial dental programs
The entries below cover the programs named in the federal coordination fact sheets. Rules can differ between programs in the same province. Check the exact name on your coverage documents, not just where you live.
Alberta
Programs: Low-income health benefits, including Assured Income for the Severely Handicapped (AISH), Alberta Adult Health Benefit, Alberta Child Health Benefit, Income Support, Children's Services, Child and Youth Support, Family Supports for Children with Disabilities, and Supports for Permanency; plus the Dental Assistance for Seniors Program.
Payment order: CDCP first; Alberta Blue Cross processes the provincial claim second.
Low-income programs: Additional payments may be available within provincial limits. When a program supplements CDCP fees, balance billing is prohibited. Charges may still apply for ineligible services or when the provincial program pays nothing, including because a limit has been reached.
Seniors' program: It does not necessarily cover the remaining fee difference. In the government's example below, it adds no payment.
| Payment | CDCP + AISH | CDCP + seniors' program |
|---|---|---|
| Dental office's charge | $143.85 | $143.85 |
| CDCP payment | $118.64 | $118.64 |
| Provincial payment | $25.21 | $0 |
| Amount chargeable to the patient | $0 | $25.21 |
The seniors' program recognizes $98 for this exam, below the CDCP payment in this example. These illustrative figures are not a quote for your treatment.
British Columbia
Programs: BC Healthy Kids; BC Employment and Assistance (BCEA); and Strengthening Abilities and Journeys of Empowerment (SAJE), the post-majority program.
Payment order: CDCP first; BC second, through Pacific Blue Cross.
What may be covered: BC may contribute to the difference between the CDCP payment and the office's charge, within its program fee schedules and limits.
Limits do not add together: In the government's example, the CDCP covers four units and Healthy Kids covers two. The programs coordinate on the first two units, and the CDCP alone covers the next two. They do not provide six units of coverage.
Exceptions: The At-Home Program does not coordinate with the CDCP. The fact sheet also states that children in care who are not part of a family tax unit cannot enrol in the CDCP. People aged 18 or older receiving BC benefits may apply if they meet CDCP requirements; they do not need to wait until 19.
Manitoba
Programs: Dental benefits through Employment and Income Assistance (EIA) and Manitoba Supports for Persons with Disabilities (MSPD).
Payment order: CDCP first; the Manitoba Department of Families second.
What may be covered: Where Manitoba's recognized service fee is higher than the CDCP fee, the province may pay an additional amount up to its fee guide. Equal or lower provincial fees do not produce an additional fee payment under that rule.
What isn't covered: Patients with CDCP coverage and provincial coverage are responsible for paying directly to the provider any co-payments or balance billing fees.
Restorative-treatment rule: Providers can seek reimbursement for fees not covered by the CDCP, up to $600 in any 12-month period. The fact sheet states that a balance remaining after this coordination is not to be charged to the patient. This is a specific rule for restorative treatments, not a promise of no charges for all dental care.
Before treatment: Check whether approval is required from both the CDCP and Manitoba.
New Brunswick
Programs: Healthy Smiles Clear Vision and the Health Services Dental Program.
How coverage works: These programs do not currently coordinate payments with the CDCP. Patients choose whether to access provincial benefits or the CDCP; one does not pay the remainder of the other's claim.
Before treatment: Ask the office to compare coverage and patient costs under each available option, and confirm which program will be used. Choosing the CDCP may leave you with a co-payment and other charges it does not cover.
Healthy Smiles Clear Vision remains a government program even though Medavie Blue Cross administers it. Public-program status and coordination are separate questions.
Newfoundland and Labrador
Programs: Children's Dental Health Program, Income Support Program, Low Income (Access) Program, and Adult Dental Program.
Payment order: CDCP first; Newfoundland and Labrador is the payer of last resort. Provincial claims go through MCP TeleClaim.
What may be covered: An additional fee payment may be available where the provincial program fee exceeds the CDCP fee, up to the program's fee guide. No additional fee payment is available under this rule where the provincial program fee is equal to or lower than the CDCP fee.
What is not covered: Patients with CDCP coverage and provincial coverage are responsible for paying directly to the provider any co-payments or balance billing fees.
What to confirm: Each program's treatment limits and any co-payment or remaining costs you must pay after both claims are assessed.
Nova Scotia
Payment order: Usually CDCP first, Nova Scotia second. Providers may bill the Maxillofacial Prosthodontics Program or Oral and Maxillofacial Surgery Program first for eligible services.
Department of Health and Wellness programs
These include the Individuals with Special Needs Health Program, Children's Oral Health Program, Cleft Palate-Craniofacial Program, Maxillofacial Prosthodontics Program, and Oral and Maxillofacial Surgery Program. Green Shield Canada administers these benefits.
The provincial program can contribute to remaining eligible costs, including co-payments, within its fee maximum. Providers cannot bill patients above the applicable provincial program fee when coordinating eligible care.
Employment Support and Income Assistance (ESIA) and Disability Support Program (DSP)
These programs can contribute to remaining eligible charges, but patients may be billed amounts left after both programs pay. Unlike the Health and Wellness programs, they do not provide the same balance-billing protection. ESIA and DSP have no frequency limits under the provincial guidance. ESIA clients should bring their MSI health card.
What to confirm: The exact program covering your care. Services ineligible under the provincial program, or beyond an applicable limit, may still be chargeable.
Ontario
Healthy Smiles Ontario (HSO) and Ontario Disability Support Program (ODSP)
Payment order: CDCP first; Ontario second, through Accerta. These programs may contribute to remaining fees within their schedules. Balance billing is prohibited when their schedules supplement CDCP fees.
For example, Ontario's fact sheet shows a $35 polishing charge, with $8.75 paid by the CDCP and $12.67 by HSO or ODSP. The remaining $13.58 cannot be billed to the patient. This example is for a patient with no CDCP co-payment only; the actual fee for service may differ.
Ontario Works (OW)
The federal guidance identifies the CDCP as the first payer. However, municipalities and First Nations communities administer Ontario Works dental benefits. The office must check with your local Ontario Works office about the coordination process and any additional coverage.
Ontario Seniors Dental Care Program (OSDCP)
OSDCP does not coordinate payments with the CDCP. Services covered under OSDCP are delivered through Public Health Units rather than funded on a fee-for-service basis. Patients can choose which program to access, but cannot expect OSDCP to pay a remaining CDCP bill. Ask about costs and how to access care under each program before deciding.
Prince Edward Island
Programs: Provincial Dental Care Program and Cleft Palate Orthodontic Funding Program.
Payment order: CDCP first; Health PEI second.
What may be covered: An additional payment on fees may be available where PEI's program fee exceeds the CDCP fee, up to the provincial fee guide. Equal or lower provincial fees do not produce an additional fee payment under that rule.
What is not covered: Patients with CDCP coverage and provincial coverage are responsible for paying directly to the provider any co-payments or balance billing fees.
What to confirm: Service eligibility, treatment limits and any remaining patient costs.
Quebec
Programs: RAMQ dental coverage for children under 10; eligible financial-assistance recipients with a claim slip and their dependants; and other dental programs funded by the Ministère de la Santé et des Services sociaux.
How coverage works: Quebec is the only payer for services covered by its dental programs. The CDCP does not add a payment for those services.
For RAMQ-covered care: If a dentist is not participating in RAMQ, they cannot choose to bill the CDCP instead for RAMQ-covered treatment. Ask about RAMQ participation before booking.
For other care: A service not covered by the applicable Quebec program may be submitted to the CDCP if it meets CDCP requirements and your coverage is active on the treatment date. For other ministry-funded programs, the guidance also specifies that if a service not covered by a provincial program is provided on a fee-for-service basis, claims can be submitted for coverage under the CDCP.
You may still have a CDCP co-payment or other uncovered costs for eligible care billed to the CDCP.
Saskatchewan
Programs: Supplementary Health and Family Health dental benefits.
How coverage works: These provincial benefits do not supplement CDCP payments. The CDCP is the only payer in this provincial-CDCP arrangement for people enrolled in the program. Saskatchewan remains the first payer for eligible provincial-program clients who are not enrolled in, or eligible for, the CDCP.
What this means for costs: Do not expect the provincial dental benefit to cover your CDCP co-payment or remaining bill. Before changing coverage, ask the program administrator and dental office how the rules apply to your benefits and planned treatment.
Northwest Territories
Programs: Métis Health Benefits and Extended Health Benefits.
Payment order: CDCP first; territorial benefits second, through Alberta Blue Cross.
What may be covered: Additional reimbursement on fees may be available where the territorial program's fee exceeds the CDCP fee, up to its fee guide. The fact sheet notes that the schedules are similar for many services, so an additional payment is not assured.
What to confirm: Remaining benefit limits, your co-payment and any amount neither program pays. Having both programs does not add their treatment-frequency allowances together.
Nunavut
Program: Extended Health Benefits (EHB).
Payment order: CDCP first; EHB second, through a patient reimbursement process.
How payment works: The office bills the CDCP through Sun Life. You pay the part of the invoice not reimbursed by the CDCP, including any applicable co-payment. Eligible EHB members may then seek reimbursement for remaining costs, up to an annual limit of $1,000, subject to EHB rules.
What to keep: The Sun Life Explanation of Benefits, invoices and receipts. Confirm the required documents and your remaining annual entitlement with EHB before treatment.
This is reimbursement from EHB for the remaining costs. It is not reimbursement from the CDCP, and it does not require you to advance the CDCP-covered portion.
Yukon
Programs: Yukon Dental Program (YDP), Extended Health Care Benefits for Seniors, and Yukon Children's Dental Program.
Payment order: CDCP first. Depending on eligibility, YDP may pay second and Extended Health Care Benefits third. For children receiving Children's Dental Program benefits, that program pays after the CDCP.
For eligible services, additional payments on fees may be available where Yukon program fees exceed CDCP fees, within the territorial program's annual limit.
YDP: It can cover CDCP co-payments for eligible services within its $1,300 annual limit. This is not an additional $1,300 co-payment allowance. YDP does not cover services received before enrolment.
Children's program: The child must be enrolled and have a program referral. Coverage is limited to referred or preauthorized services, with one exam per referral. It does not cover dental services provided outside Yukon.
What to confirm: Which programs you qualify for, their remaining limits and the claim sequence. Pacific Blue Cross processes YDP and seniors' benefit claims; the children's program uses its own claims process.
Before your appointment: Four things to confirm
- Tell the office about every dental program you have. Ask whether it can provide care and submit claims under each relevant program, not just the CDCP.
- Confirm your coverage is active. Bring your CDCP member information and other program documents. Check your start date and co-payment level; an old card alone does not confirm current eligibility.
- Ask for a written, itemized estimate. It should show the office's charges, each program's expected contribution and what you may owe. Ask whether any remaining fee is prohibited by the program's billing rules.
- Confirm approvals, limits and claim responsibilities. Ask which approvals are needed, whether you have benefits remaining and whether the office or you must submit the second claim.
A useful question is: "For this treatment, what is each program expected to pay, and what amount am I responsible for?"
Common questions about combining government dental benefits
Does my provincial program change my CDCP co-payment percentage?
No. Your CDCP percentage is based on adjusted family net income. Another program may contribute to eligible costs, including some co-payments, without changing that percentage. Confirm its rules and limits rather than assuming the full co-payment is covered.
What if one program pays nothing?
A zero payment does not necessarily mean a mistake. The program may recognize a lower fee, have reached a limit or not cover that service. Ask for the reason shown on the claim assessment and an explanation of any amount charged to you. The amount unpaid and the amount billable to you can differ.
What if I have three government programs?
Have the office confirm the complete order with the relevant administrators rather than combining two separate billing rules yourself. Yukon's guidance, for example, allows the CDCP, then YDP, then Extended Health Care Benefits where applicable. That sequence is specific to those programs, not a nationwide rule for every combination.
Should I cancel my existing government coverage after joining the CDCP?
Do not assume it is redundant. Some programs can still contribute, while others do not combine payments with the CDCP. Check your program's section and speak with its administrator before changing enrolment. The answer depends on your program, not simply on having CDCP coverage.
Find a dentist who accepts the CDCP
Use hellodent to find a dental practice accepting CDCP patients. When you contact the office, tell the team about your other government dental benefits and ask how it handles those programs before your appointment.
Find a dentist who accepts the CDCP
This guide provides general information, not confirmation of individual eligibility, coverage or treatment costs. Program rules and fees can change. The official guidance and your program administrator are the sources for current requirements; your dental office can confirm the proposed treatment and estimated patient costs.
The content provided in this article, including text, graphics, and referenced material, is intended for informational purposes only and is not a substitute for professional dental advice, diagnosis, or treatment. Always consult with your dentist or another qualified oral health professional for questions regarding your dental condition. Never disregard professional dental advice or delay seeking it based on information from this article. If you believe you have a dental emergency, contact your dentist, or seek immediate assistance from an oral healthcare professional.
