The federal government’s Canadian Dental Care Plan (CDCP) was launched with the promise of helping millions of Canadians access essential oral healthcare. But as the program rolls out, gaps in coverage, communication, and implementation are becoming harder to ignore – and for brokers, these gaps can mean both risk and opportunity when advising clients.
For Andrew Ostro (pictured), co-founder and CEO of digital insurance platform PolicyMe, the plan’s intent is sound, but the execution still has major shortcomings that could limit its effectiveness. Understanding those gaps can help brokers better position private coverage options, manage client expectations, and protect long-term relationships.
“More Canadians getting access to dental care is a big win,” Ostro told Insurance Business. “But in its current form, there are a few gaps that are worth addressing.”
One of the biggest sources of frustration for Canadians trying to navigate the CDCP is the co-payment structure, particularly for middle-income households.
Under the current rules, as Ostro explained, families with an adjusted net income under $70,000 receive full dental coverage through the program. But just above that threshold, the support drops steeply: 60-percent coverage for those earning between $70,000–$79,999, and only 40 percent for those earning $80,000–$89,999.
This can lead to situations where small income changes can result in disproportionate reductions in support, without enough clarity on what that means for patients’ actual bills.
“These sudden shifts can leave families unsure of how to think about their coverage and plan for future care,” he said.
It’s a problem that not only affects affordability, but also trust. For households already grappling with tight budgets, the lack of predictability can make it harder to commit to preventive or ongoing dental care – potentially undermining the program’s long-term goals.
For brokers, these sudden shifts in support are a key client education opportunity. Clients may not realize how small changes in income could affect their benefits, or how to budget for potential out-of-pocket costs.
Even for those who qualify under the plan, costs aren’t always fully covered.
CDCP reimbursement rates (the amount the government is willing to pay for certain dental procedures) often fall below what providers typically charge in their province or territory. That, Ostro said, leaves patients stuck paying the difference.
“This can be particularly frustrating for those already financially stretched,” Ostro said, especially when the plan is marketed as a comprehensive benefit for low- and moderate-income families.
The risk is that the very Canadians the plan was designed to help may avoid going to the dentist altogether, not because they’re ineligible, but because they fear surprise bills or can't afford top-ups.
“If the goal is to build long-term trust and uptake among both patients and providers, the plan needs to double down on clarity, streamline the experience, and work more closely with the dental community to get it right,” Ostro said.
For many Canadian dental clinics (particularly smaller or independently run practices) the CDCP’s ambiguity has created a challenging operational environment, Ostro pointed out. The intention to make care more accessible, he added, is welcomed by providers, but a lack of clarity around reimbursement, billing, and eligibility is making it harder to deliver on that promise.
“The uncertainty adds pressure,” Ostro said. “They want to support their patients, but without clear guidance on what they'll get paid and when, it’s hard to commit.”
Administrative workloads have become a major sticking point, Ostro said. Dental teams are already stretched thin, and the additional complexity introduced by CDCP’s co-pay tiers and billing structures has only added to that burden.
The administrative friction is also feeding into broader trust issues. Clinics need to know that their time will be compensated fairly and promptly. That means improving how the program communicates with providers – and how predictable the reimbursement process is.
“Clearer communication, better coordination, and smoother processes would go a long way in helping providers stay engaged,” Ostro said.
A core frustration across the dental community has been the CDCP’s fast-paced rollout, and the incomplete information that came with it.
One especially thorny issue has been the definition of “access to private coverage”, a key factor in determining patient eligibility under the CDCP.
“That kind of ambiguity has led to avoidable claim rejections and frustration,” Ostro said.
For brokers, this matters because it can impact client access to preferred providers. If a client’s regular dentist opts out of CDCP participation due to uncertainty or administrative strain, the broker may need to help identify alternative options or explain how private coverage could bridge the gap.
As the CDCP continues to evolve, one of the most important questions facing policymakers and providers alike is how public dental coverage will interact with private and employer-sponsored plans. Currently, the two systems operate more like rivals than partners – and that, Ostro argues, is a missed opportunity.
“Yes, and that’s where I think we’re headed,” Ostro said, when asked whether he sees hybrid coverage models emerging. “CDCP can serve as a foundation, especially for those who don’t currently have access to coverage.”
But for that foundation to support long-term dental care sustainability, Ostro believes it must be designed to complement, and not displace, private insurance.
He also said brokers can help identify blind spots and suggest affordable top-up options to insureds.
This kind of advisory approach, Ostro added, is becoming more essential in a market that’s only getting more complex.
“Right now, even minimal private coverage disqualifies someone from CDCP, which creates a real tension point,” he said. “That kind of design discourages coordination and limits flexibility for people who could benefit from both.”
