Don’t call it insurance: What dentists want you to know about federal dental plans

Ottawa –

The federal government’s newly unveiled vision for a comprehensive set of dental benefits looks a lot like typical insurance coverage, right down to the ID that patients submit at the dentist’s office.

But industry advocates say the new plans are different from the coverage Canadians typically get from their employers, and there are some important differences that patients need to be clear about.

“I just don’t want people to think this is a free program,” said Dr. Brock Nicolucci, president of the Ontario Dental Association.

“We don’t have any details yet, and if people start dropping the dental insurance that they worked so hard for… I’m going to feel very sad for people.”

The federal program will begin accepting enrollment applications this month for eligible seniors age 87 and older. Over the next year, registration eligibility will slowly expand to include all seniors, children under 18 and people with disabilities.

The plan was developed at the request of the NDP as part of a political deal to ensure the opposition supported the government on key votes.

The program is open to low- and moderate-income people who are not yet insured.

“This is not an insurance plan,” Nicolucci said. “This is a benefit provided by the government to Canadians who, unfortunately, don’t have access to health care.”

Dr. Carlos Quinones, associate dean and dean of the School of Dentistry at Western University in London, Ont., said seniors may choose to stop paying for private insurance in favor of government programs.

“I don’t think it’s a problem, but it’s a real problem,” Quinones said in an interview.

A 2022 Statistics Canada survey found that 32.5 per cent of seniors have private dental insurance, which they either pay for themselves or purchase through their employer. That’s only a small portion of the third-party insurance market, Quinones said, and private coverage tends to be less robust than employer plans.

Nicolucci said he hopes people won’t abandon their personal insurance to seek government-funded care, at least until the parameters of the new program become clearer.

The scheme will allow patients with annual household incomes of less than $70,000 to avoid paying for dental services, while patients with annual household incomes of $70,000 to $90,000 will pay 40 per cent to 60 per cent of the cost.

The cost to patients is unclear because dentists have not yet seen the full list of benefits that will be covered or how much the government program will pay for each service.

The basket of services will closely mirror federal health benefit programs for enrolled First Nations and Inuit people, Health Canada officials said in a briefing provided Monday on condition of anonymity.

Dr. Robert Wolansky, president of the British Columbia Dental Association, said the plan, called the Non-Insurance Health Benefits Plan, has some significant differences from employer insurance plans in terms of eligibility criteria and administrative burden for oral health providers and patients. .

He said some dentists are avoiding patients in the program out of concern that the program requires a lot of paperwork, creating “dental deserts” for enrolled patients who can’t find a care provider.

Health Canada officials say they have learned from the experience, and Health Minister Mark Holland said Monday that getting oral health providers on board is key.

“I think we’ve had a very productive conversation based on that, so I’m very optimistic that there’s going to be a very strong uptake,” Holland said.

Dentists don’t yet know how patients’ experiences at appointments will be different because the federal government has yet to release those details.

But Wolansky said people must remember that unlike private insurance plans, people must requalify for coverage every year.

“In order to qualify, you have to meet certain criteria in terms of income, right? That doesn’t exist in private insurance,” said Wolanski, a dentist from Nanaimo, B.C.

Under the new government program, patient eligibility and costs may change from year to year based on their income.

Details of the scheme are expected to be fleshed out by May 2024, when the first group of scheme members are expected to start being able to apply for dental services through the government scheme.

This report by The Canadian Press was first published Dec. 12, 2023.

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