Three income lines decide how much of a dental bill the federal plan pays

The Canadian Dental Care Plan is now open to residents of every age, and applications for the 2026-2027 benefit period are being accepted. It is not universal, though, and it is not quite insurance in the way a workplace plan is. Whether a household qualifies, and how much of each bill it still pays, comes down to a handful of lines on last year's tax return and one question about other coverage. Here is how those pieces fit together.

Test one: no access to private dental insurance

This is the rule that disqualifies most people who otherwise would be eligible. You cannot have access to dental coverage through your own or a family member's employer or pension plan, through a professional or student organization, or through a policy you bought yourself. "Access" is the operative word: coverage you have never used, do not pay for, or that covers only part of your costs still counts. Declining a workplace plan does not make you eligible. There is a narrow exception for retirees who opted out of a pension plan's dental coverage before 11 December 2023 and cannot opt back in.

The CRA slips do the checking. Box 45 on a T4 (box 015 on a T4A) shows a code of 1 if no dental coverage was offered; codes 2 to 5 mean some coverage was available to you or your family. Service Canada compares your attestation against these slips, including your spouse's.

Tests two to four: income, residency, and a filed return

Your adjusted family net income must be less than $90,000. That is family net income (line 23600 for each spouse), minus any Universal Child Care Benefit and RDSP income, plus any repayments of those amounts. You and your spouse or common-law partner must both be residents of Canada for tax purposes and must both have filed a tax return for the previous year, since the income figure comes straight from the Notice of Assessment. A household that files late or not at all cannot be assessed, which is the same mechanism behind the GST/HST credit and the Canada Child Benefit.

Coverage through a provincial, territorial or federal social program does not disqualify you; the plans are coordinated so that the same service is not paid twice. Residents of provinces with public dental programs for children or people receiving social assistance, Quebec among them, can still hold CDCP coverage for the rest.

What you still pay: the three co-payment tiers

The plan does not pay the whole bill for everyone. Three income bands set the share of the CDCP fee that the plan covers, and the remainder is your co-payment, paid to the dentist directly.

Tiers from canada.ca, November 2026. The $400 is an assumed CDCP fee for a routine visit. If the provider charges more than the CDCP fee, the difference is added to your share in every tier.

CDCP fees are not the dentist's fees

This is the detail that surprises people at the front desk. The plan reimburses providers according to its own fee schedule, and that schedule "may not be the same as what providers charge." A dentist who charges above the CDCP fee can bill you the difference, on top of any co-payment. The sensible habit is to ask, before the appointment, whether the clinic accepts CDCP patients, whether it bills Sun Life directly, and whether its fees exceed the plan's. Only providers are reimbursed; if you pay the full amount yourself, Sun Life cannot refund you afterwards.

The plan pays a share of its own fee schedule, not a share of whatever the dentist charges.

What is covered, and what needs approval first

Covered services fall into four groups: diagnostic and preventive care (exams, x-rays, cleaning, fluoride, sealants); basic care (fillings, root canals, gum treatment); major care (crowns, posts and cores, full and partial dentures, extractions); and anesthesia or sedation. Orthodontics is not available. Many services are covered without any paperwork, but some, including deeper sedation, general anesthesia and anything beyond the plan's frequency limits, require preauthorization. Approval is assessed against your oral health history and must be in place before the treatment; a request is not automatically granted. You can still go ahead without approval and pay the provider yourself.

Good to know

Dental costs you pay yourself, including CDCP co-payments and balance billing, can count towards the medical expense tax credit. Keep the receipts.

Applying, and the yearly renewal

Applications are made online through My Service Canada Account, through a Canada.ca form if you cannot use MSCA, or by phone to Service Canada at 1-833-537-4342 (TTY 1-833-677-6262). Each applicant needs a Social Insurance Number where available, date of birth, address and details of any government dental coverage; a spouse or partner applies separately. An enrolment letter then confirms the start date, member ID and co-payment level, and Sun Life mails a welcome package with the card. Only care received after the start date is covered, so appointments should wait for the letter.

Coverage runs in benefit periods ending each year on 30 June, and members must renew every year to confirm they still meet the four tests, with the previous year's return filed and assessed. For the 2025-2026 period the renewal window closed on 1 June 2026; renewals for 2027-2028 are expected to open in spring 2027. Missing the window means applying afresh, with a gap in coverage, and the plan states plainly that care received during a gap is not reimbursed retroactively. Applying and renewing cost nothing, and no one from the plan will ask for banking or card details.

Who this matters for, and what to check

• Households without any workplace, pension or private dental plan: check box 45 on each T4 (box 015 on a T4A) to see what Service Canada will see.
• Add line 23600 for both spouses, adjusted as described, to find your tier; a figure near $70,000 or $80,000 can shift your co-payment by 40 or 60 percentage points.
• File last year's return, both spouses, before applying or renewing.
• Before booking, ask the clinic whether it accepts CDCP, bills Sun Life directly, and charges above the CDCP fee.
• Put the renewal window (spring each year, before 30 June) in the calendar.

The takeaway

The CDCP turns on four facts a household can check in an afternoon: other coverage, income under $90,000, residency, and a filed return. The co-payment tiers decide how much of the plan's fee you carry, and the gap between the plan's fee and the dentist's fee decides the rest. Treat it as a benefit that is renewed, not held, and ask the fee questions before the chair, not after.