Dental coverage for seniors/disabled | Page 2 | Your stories | Discussion forum

Please consider registering
guest

sp_LogInOut Log In sp_Registration Register

Register | Lost password?
Advanced Search

— Forum Scope —




— Match —





— Forum Options —





Minimum search word length is 3 characters - maximum search word length is 84 characters

No permission to create posts
sp_Feed Topic RSS sp_TopicIcon
Dental coverage for seniors/disabled
May 25, 2024
2:06 pm
Norman1
Member
Members
Forum Posts: 6910
Member Since:
April 6, 2013
sp_UserOfflineSmall Offline

MG said
I have heard that most dentists do not participate in the program. I think less than 20% do. So, even if you qualify and sign up, you may not be able to continue to see your own dentist who has all your records, etc. …

Ask the dentist if he/she would consider accepting payments from CDCP after July 8.

After July 8, federal government won't require dental providers to agree to additional conditions except to direct bill the covered portion. Dental provider must direct bill the covered portion to CDCP. Patient cannot be required to pay in full first and then seek reimbursement from CDCP for the covered portion.

CBC (Apr 17, 2024): Dentists can bill for federal dental plan patients without signing up for program, government says

Starting in early July, oral health providers can bill Sun Life — which manages the dental care program — for services on a claim-by-claim basis without signing up for the CDCP.

"This also means that CDCP clients can see any oral health provider they choose for their care, as long as the provider agrees to direct bill Sun Life for services provided under the plan," the federal government's announcement said.

May 25, 2024
2:27 pm
CAD
Member
Members
Forum Posts: 43
Member Since:
January 25, 2024
sp_UserOfflineSmall Offline

Alexandre said

MG said
Yes, some dentists charge fee for patient data transfer, but does that transfer even necessary? As long as you did regular checkup, cleaning, let dentist take care of problems as they appear, you could start anew.

All it takes to start with new dentist is one hour "Complete Exam" at the first visit. X-rays will be taken, etc.
For senior with 100% coverage the out of pocket cost could be under $50. Considering future savings, that is not much of an expense.  

I tend to agree. Your teeth do not grow nor change over time. They might become worn out or caps added or implant but they do not change to have history of each one. So yes, you can start from scratch with new dentist.

'Minor' issue is what if you are with current dentist for years and year (20, 30+) and you know how he/she works and can talk and explain what bothers you and he/she know you (your mouth/teeth) very well?
Are you going to throw that history away? HOW do you know new dentist knows his job? Not all dentists are equal! And you do NOT have to have ONE dentist. This is not like family physician where you are attached to one and one only.
You might do cleaning and exam at dentist participating in CDCP (and save few bucks) and go for drilling at your 'old' dentist.

May 25, 2024
2:40 pm
Dean
Valhalla Mountains, British Columbia
Member
Members
Forum Posts: 1992
Member Since:
January 12, 2019
sp_UserOfflineSmall Offline

.
And then there's the School-Of-Thought that says . . .

    "When the dentists who don't participate in this new program start to lose patients (business) to those dentists who do, they too will also start to participate in the program."

Time will tell . . .

    Dean

sf-cool " Live Long, Healthy ... And Prosper! " sf-cool

May 26, 2024
4:01 pm
Norman1
Member
Members
Forum Posts: 6910
Member Since:
April 6, 2013
sp_UserOfflineSmall Offline

The dentists will join once the CDCP plan becomes just like other dental plans, like the ones from people's employer.

Apparently, the federal government had tried some underhanded things with the dentists behind the scenes and the dentists pushed back. This is from one dentist in April, before the federal government started to smarten up:

Here are some of the reasons why I am encouraging us [dentists] all to say NO to the CDCP:

1. The CDCP is not free for patients, as dentists must balance bills to ensure their dental practice’s economic viability. For example, Manitoba’s established CDCP fee grid is 74% of the MDA 2024 fee guide. The government encourages all dentists not to balance bills [to not bill patients for the remaining 26%]. That means, essentially, we work for free. Why are some provinces reimbursed at a higher percentage? Should not every dentist be reimbursed the same percentage of their provincial fee guides?

2. It doesn’t protect the patient’s choice of dentist. The federal government has created an American-style HMO system where the patient can choose a provider from ‘in-network’ – if your current provider is ‘outside of the network,’ the patient cannot continue to see them and access the CDCP. The government has set us up to be greedy rich dentists who do not help the poor.

3. The administrative burden makes it difficult for patients to get the necessary care and for practices to run efficiently. How does the dental office know the family income to monitor the patient’s remaining balance on the CDCP properly? We must check the Sunlife portal before any treatment to ensure that the patient is eligible for any treatment before it is done or fear that Sunlife (who wants access to our bank accounts) will claw payments back. Sunlife will also have the right to come into our practices and audit us anytime! How did Sunlife become the sole benefactor of this billion-dollar government gift in the first place?

May 27, 2024
8:04 am
CAD
Member
Members
Forum Posts: 43
Member Since:
January 25, 2024
sp_UserOfflineSmall Offline

Norman1 said
That means, essentially, we work for free.

  

HOW MUCH MORE dentists want to earn???
Equipment and material they purchase is tax deductible (most likely).
Salaries they pay is most likely tax deductible too.
They charge arm and leg for simple filling.
Cleaning (less than 1h of work) is >$200. Person doing it gets a cut of that and dentist benefits too.

Look at family physicians: they schedule appointments in blocks of 15 min, you can present only ONE issue per visit, spend 2-3 min with you, and then run away. Most of them refer you to somebody else (specialist or to do some test) or write prescription. When tests are done they just read you what is the result without further explanation. Some require NEW appointment to tell you test results...
I used to have FP who would LISTEN and spend 10-15 min explaining what is going on, how to prevent future occurrences and what will be the best approach to remedy issue. Unfortunately he retired long time ago...

May 27, 2024
8:32 am
Alexandre
Member
Members
Forum Posts: 1189
Member Since:
November 8, 2018
sp_UserOfflineSmall Offline

Norman1 said
The dentists will join once the CDCP plan becomes just like other dental plans, like the ones from people's employer.

Apparently, the federal government had tried some underhanded things with the dentists behind the scenes and the dentists pushed back.

 

2,000,000 seniors already signed for CDCP. Such large rollout is expected to have some glitches. Tuning the process may be required.

For once, the government did something smart and delayed mass signup till 2025, giving 6+ months to fix issues for smaller group of people.

We must check the Sunlife portal before any treatment to ensure that the patient is eligible for any treatment before it is done or fear that Sunlife will claw payments back.

This complaint is totally ridiculous. Yes, before providing the treatment covered by insurance plan the patient must have an estimate. That estimate must split the cost between what insurance pays and what patient will pay.
Nothing new here.

----------------

I am thinking that unintended side benefit from CDCP will be closing of dental practices that get paid for their services by cash under the table and, perhaps, not even have properly licensed in Canada dentists.
They exist now, because they can provide services cheaper than reputable dental establishment. Their customer base is exactly those who will qualify for maximum coverage under CDCP.

If you ask me, I am all for it.

May 27, 2024
7:11 pm
Norman1
Member
Members
Forum Posts: 6910
Member Since:
April 6, 2013
sp_UserOfflineSmall Offline

Alexandre said

We must check the Sunlife portal before any treatment to ensure that the patient is eligible for any treatment before it is done or fear that Sunlife will claw payments back.

This complaint is totally ridiculous. Yes, before providing the treatment covered by insurance plan the patient must have an estimate. That estimate must split the cost between what insurance pays and what patient will pay.
Nothing new here.

That is new for dentists who will do the forms or claims but don't bill insurance plans.

Dentists don't normally do pre-determinations for routine work like cleanings. Dental plans don't require such pre-determinations because they aren't going to reject claims for things like the annual or semi-annual cleaning.

Those pre-determinations also don't reserve room in the annual plan limits like a credit card pre-approval does in a card's spending limit. I was suprised once when the pre-determination said over $300 would be covered. I received less than $100 after I filed the claim because I didn't have $300+ left in my annual plan limit!

That's what the dentist meant that he would need to monitor the patient's CDCP balances and check not only when estimating the treatment but also later when the patient returns to have the treatment.

Some dentists will hire staff to do all that so patients can pay just the uncovered portion and not receive a surprise adjustment bill later. Other dentists are not willing to do that.

May 28, 2024
5:24 am
COIN
Member
Members
Forum Posts: 1124
Member Since:
March 15, 2019
sp_UserOfflineSmall Offline

If someone already know the answer, it will save me researching it.

Question: Is eligibility means tested?

May 28, 2024
7:00 am
Norman1
Member
Members
Forum Posts: 6910
Member Since:
April 6, 2013
sp_UserOfflineSmall Offline

Eligibility is not means tested but income tested. Among the eligibility requirements are one needs to file last year's tax return and one's adjusted family net income is under $90,000.

CDCP: Do you qualify? has the full details.

There is also reduction in coverage when adjusted familiy net income is $70,000 or more:

Co-payments based on adjusted family net income
Adjusted family net income How much will the CDCP cover How much you will cover
Lower than $70,000 100% of eligible oral health care service costs will be covered at the CDCP established fees. 0% of the CDCP established fees. You may face additional charges as described below.
Between $70,000 and $79,999 60% of eligible oral health care service costs will be covered at the CDCP established fees. 40% of the CDCP established fees. You may face additional fees as described below.
Between $80,000 and $89,999 40% of eligible oral health care service costs will be covered at the CDCP established fees. 60% of the CDCP established fees. You may face additional fees as described below.
May 28, 2024
12:42 pm
toto
Member
Members
Forum Posts: 307
Member Since:
August 17, 2010
sp_UserOfflineSmall Offline

The program must have annual limits that can't be very high, I can't see that on the info. So maybe enough for an exam and cleaning say? I dont qualify , but was thinking if limits are high , where is Canada going to get the money for this?

May 28, 2024
3:02 pm
RetirEd
Member
Members
Forum Posts: 1076
Member Since:
November 18, 2017
sp_UserOfflineSmall Offline

Norman1:

That means, essentially, we [dentists] work for free.

That's a stretch. Not free, but for regulated amounts. When medical coverage came to Canada, similar complaints were made by medical associations. They eventually realized they were trading their ability to set fees for guaranteed payment on a much larger pool pf patients.

Before that, the medical argument was that doctors could pick their patients and set their fees, and often provided free "pro bono" work. We don't know how many actually did, or how much of it. Or how many deadbeat (or dead) patients the had to write off.

Now, they always get paid.

On the other hand, some specialists working in non-covered medicine cherry-pick only wealthy patients and charge very high fees. Cosmetic procedures, or procedures that can be covered but can also be interpreted as part of non-covered procedures (such as cataract surgery with complications or extra-value add-ons like special lenses), are popular targets for this upselling. (Oh, you can wait for x months, but it you also do this too you can have it next week!) This is said to be one reason why there is increased student interest in specialties and less in general medicine.

My current dentist, who tells me he is a "non-registered" participant in the new program, used to offer a 10% discount to seniors - but I noted that his work classification seems to move work into a higher category that I would assess. Now he'll get the full federal fee schedule amount.

Given the immense cost in both money and human health of lack of dental access, I'm happy to see the new program and hope it will continue to improve. So far no Canadian political party has been willing to campaign on killing the program.

While US Republicans have both boasted and tried to remove the US Affordable Care Act, the US public has consistently supported the Act.

[Hmm... there's a joke waiting to be made about that...]

RetirEd

May 28, 2024
7:07 pm
Norman1
Member
Members
Forum Posts: 6910
Member Since:
April 6, 2013
sp_UserOfflineSmall Offline

RetirEd said

Norman1: That means, essentially, we [dentists] work for free.

That's a stretch. Not free, but for regulated amounts. When medical coverage came to Canada, similar complaints were made by medical associations. They eventually realized they were trading their ability to set fees for guaranteed payment on a much larger pool pf patients.

Before that, the medical argument was that doctors could pick their patients and set their fees, and often provided free "pro bono" work. We don't know how many actually did, or how much of it. Or how many deadbeat (or dead) patients the had to write off.

Now, they always get paid.

So what if they will always be paid? That only makes sense if the guaranteed billings are not far from non-guaranteed ones.

Prince George dentists not signing up for federal dental care program gives this example:

The CDCP fee guidelines are significantly lower than BC fee rates for procedures.

As an example, Foy said in the case of tooth extraction that costs $160, the government fee for that service is only $50, of which the plan would cover only a percentage of that.

If I were the dentist, I would choose to collect $160 most of the time over $50 all the time!

Yes, the dentist would be working for free if he or she accepts the CDCP rate and has no profit left after paying the expenses. Just like some women end up working for free when their salary just covers the child care costs.

Initially, I could not understand what all the fuss was about. Why would the dental providers not accept CDCP? Just another dental plan through SunLife, no?

Turns out it isn't. Misleading claims about it being "free dental" with 100% coverage. US-style HMO setup restricted to certain providers. Behind the scenes "encouragement" to not bill patients the difference to keep up a facade that "free dental" was actually delivered!

Federal government and politicians should just cut the BS! Just be honest and tell people they are getting 70% to 85% dental coverage, like an employer dental plan, and leave it at that.

And cut the behind the scenes nonsense with the dentists and hygienists. It takes some gall to ask someone to accept $50 for a procedure that is normally $160 so that one can say "free dental".

Fortunately, a good chunk of the BS will be going away after July 8.

May 29, 2024
7:46 am
Alexandre
Member
Members
Forum Posts: 1189
Member Since:
November 8, 2018
sp_UserOfflineSmall Offline

Norman1 said

Prince George dentists not signing up for federal dental care program 

This "blockade" will not last long. There is already dental hygienist office signed for CDCP in PE. If judging by Ontario prices, cleaning will be $250-$300 without CDCP, $30 for those with 100% CDCP coverage.
Guess where PEI residents with CDCP will go for regular cleaning and checkup.

Initially, I could not understand what all the fuss was about. Why would the dental providers not accept CDCP? Just another dental plan through SunLife, no?

Yes, it is.

I did wonder, too, why there is so much pushback on CDCP, when it is smooth sailing for me. Then, I realized my longest employer with whom I was for over a decade is with Sun Life for dental and medical insurance.
Of course, my dentist is familiar with Sun Life portal, their requirements, etc. If not, I would have had another dentist by now.

While my anecdotal experience may not be common, as not everyone has or had Sun Life insurance through employer, it is indeed another dental plan through Sun Life. With co-payments, estimates, authorization, frequency of services.
The only unknown is annual limit, if it does exist or not for CDCP and what is the amount.

May 29, 2024
1:53 pm
RetirEd
Member
Members
Forum Posts: 1076
Member Since:
November 18, 2017
sp_UserOfflineSmall Offline

Norman1: It's still not "working for free."

Some (I have no info on how many) dentists either charge more than private insurance benefits cover or (as I have seen myself) charge uninsured patients more than the fee schedules covered by those private insurers.

If I were the dentist, I would choose to collect $160 most of the time over $50 all the time!

But dentists still have the option of charging the $160 to patients who are willing to pay, and do not have to accept $50 patients who are not. Unlike federal Medicare, there's no limitation on private billing. We do know that Canadian dentists have had difficulty filling their appointment books in recent years, so those lower payments - as well as the privately-insured patients who are subject to top-up billing - are likely going to be welcome.

And the multitudes of patients who have neglected their dental health due to poverty will be healthier and less of a strain on Medicare.

RetirEd

May 29, 2024
2:10 pm
CAD
Member
Members
Forum Posts: 43
Member Since:
January 25, 2024
sp_UserOfflineSmall Offline

RetirEd said
Norman1We do know that Canadian dentists have had difficulty filling their appointment books in recent years, so those lower payments

Whaaat???
My dentist is booked solid for 3 months in advance. He Never had issue with that even with draconian measures during covid...

June 1, 2024
6:12 am
RetirEd
Member
Members
Forum Posts: 1076
Member Since:
November 18, 2017
sp_UserOfflineSmall Offline

Your dentist may be busy. Mine only bothers to schedule three days a week to save money on office staff. All the dental offices I know of in my neighbourhood (six) have posted signs saying they welcome new patients.

On the other hand, many more may have become (or are becoming) busy as the plan allows those who have not been able to afford dental care for years start coming in...

RetirEd

June 1, 2024
7:52 am
Alexandre
Member
Members
Forum Posts: 1189
Member Since:
November 8, 2018
sp_UserOfflineSmall Offline

RetirEd said

many more may have become (or are becoming) busy as the plan allows those who have not been able to afford dental care for years start coming in...  

Not only that, but also busy with people like me, who can afford full price today and not CDCP eligible until 2025. It is mid-2024, and I am pushing by 6-8 months non-critical dental work my dentist reassured me could wait, to have it done under CDCP.

In 2025, almost everyone will become eligible for new dental plan. While it is still 2024, it would make sense to verify if your dentist accepts CDCP. If they do not, there is still time to find dentist who will, and switch.

In 2025, it might be as hard to find dentist taking new patients with CDCP as it is now to find family doctor taking new patients.

June 1, 2024
7:55 am
mordko
Member
Members
Forum Posts: 889
Member Since:
April 27, 2017
sp_UserOfflineSmall Offline

We know the outcome. The government will regulate fees because the money tree is already out of money. So dentists will regulate service. Its a version of shrinkflation. They’ll use cheaper equipment, materials and staff and spend less time.

With dentistry, the effects of “free” are literally “in your face”. Its hard to not notice that Brits have much worse teeth than North Americans. And hard to find a dentist in the UK. Same as with family doctors in Canada. We are copy-pasting British system so we know the future.

June 1, 2024
8:36 am
Alexandre
Member
Members
Forum Posts: 1189
Member Since:
November 8, 2018
sp_UserOfflineSmall Offline

mordko said
We know the outcome. The government will regulate fees because the money tree is already out of money. So dentists will regulate service. Its a version of shrinkflation. They’ll use cheaper equipment, materials and staff and spend less time.

I am not eligible for CDCP yet. I went to my dentist and paid about $250 for cleaning.
I took a person on CDCP to that same dentist, they have got same $250 estimate, but paid $25 out of pocket. I assume CDCP covered $225.

I don't see how that will incentivize my dentist to cut quality of their service.

I am in Ontario. Perhaps, in provinces where government tries to convince dentists not to charge the difference, that would be the case.

------------------

Still, thanks for that. To add to my previous recommendation, if your dentist does charge very modest out of pocket fee for CDCP covered dental procedure, that means they won't be reducing quality of their work to make their service "100% free of charge."

June 1, 2024
8:59 am
mordko
Member
Members
Forum Posts: 889
Member Since:
April 27, 2017
sp_UserOfflineSmall Offline

Alexandre said

mordko said
We know the outcome. The government will regulate fees because the money tree is already out of money. So dentists will regulate service. Its a version of shrinkflation. They’ll use cheaper equipment, materials and staff and spend less time.

I am not eligible for CDCP yet. I went to my dentist and paid about $250 for cleaning.
I took a person on CDCP to that same dentist, they have got same $250 estimate, but paid $25 out of pocket. I assume CDCP covered $225.

I don't see how that will incentivize my dentist to cut quality of their service.

I am in Ontario. Perhaps, in provinces where government tries to convince dentists not to charge the difference, that would be the case.

------------------

Still, thanks for that. To add to my previous recommendation, if your dentist does charge very modest out of pocket fee for CDCP covered dental procedure, that means they won't be reducing quality of their work to make their service "100% free of charge."  

We can pick individual cases but in the end there will be a massive pressure to cut costs and the service will become harder to come by. “ It is worth noting that the UK has lower numbers of dentists per head of population compared with many other European countries. The UK has 5.3 dentists per 10,000 of the population compared with 6.5 in France, 8.3 in Italy and 8.5 in Germany.” Canada has 6.5 per 10,000. https://theconversation.com/nhs-dentistry-is-in-crisis-are-overseas-dentists-the-answer-223842#:~:text=It%20is%20worth%20noting%20that,Italy%20and%208.5%20in%20Germany.

You can argue that genuinely poor people have better access under tax-funded systems. And I am sure its partially true, at least on average as they’ll be meeting government-postulated metrics. But a friend is working in a dental clinic in Wales and they are overwhelmed/don’t accept new clients. And you have to travel for over 2 hours to get an alternative, which does not accept new patients either. In my anecdotal experience I have not come across anything like this in Canada. And being in a dentist’s office in Canada is a much more pleasant experience than in the UK (again, anecdotal).

No permission to create posts

Please write your comments in the forum.