Oral health is a crucial part of overall well-being, and regular dental check-ups are essential for preventing serious dental issues. However, due to high dental costs in Canada, many individuals delay or avoid visits to the dentist. In Ontario, the Ontario Health Insurance Plan (OHIP) provides healthcare coverage to residents, but its dental coverage has several limitations.

In this guide, we will explore the scope of OHIP dental coverage, what treatments are included, and alternative government-funded programs that help residents access dental care.

The Ontario Health Insurance Plan (OHIP) is a publicly funded healthcare system financed through tax revenues. It covers a wide range of essential medical treatments, but when it comes to dental care, the coverage is very limited. Understanding these limitations is key to planning for out-of-pocket expenses or securing private dental insurance.

What Does OHIP Cover?

OHIP provides coverage for essential medical services, including:

• Physician visits
• Hospital stays and procedures
• Laboratory tests
• Eye care services
• Podiatry (foot care)
• Ambulance services
• Travel assistance for medical care

However, OHIP dental coverage applies only to specific circumstances, primarily emergency dental surgeries performed in a hospital setting. Routine dental care is not included.

Children Under 25 & Seniors

For children under 25 and seniors, insurance may cover:

• Complex oral surgeries, such as tumor removal and jaw fracture repairs.
• Hospital-based dental procedures due to severe bone-related conditions.
• Surgical interventions necessary for medical conditions affecting the mouth, jaw, or face.

What’s Not Covered in OHIP?

• Routine dental check-ups
• Dental Fillings
• Extractions
• Cleanings
• Orthodontic treatments
• Cosmetic procedures

Who Qualifies for OHIP Dental Coverage?

To be eligible for OHIP, residents must:

• Be a Canadian citizen, permanent resident, or a refugee with valid documentation.
• Have their primary residence in Ontario.
• Be physically present in Ontario for at least 153 days per year.

How to Obtain an OHIP Card?

A valid OHIP health card is required to access covered services. Children over 15.5 years old must apply for their own card in person at a ServiceOntario center. Newcomers to Ontario must present three original documents:

1. Proof of Canadian citizenship or immigration status
2. Proof of Ontario residency
3. Personal identification

How to Maintain OHIP Coverage?

Residents must be physically present in Ontario for 153 days per year to maintain their OHIP eligibility. Individuals who travel outside Canada for extended periods should take note of the following:

• Short-Term Travel: You can leave Ontario for up to seven months in any 12-month period without losing OHIP coverage.
• Extended Absences: If leaving Canada for more than seven months, you can keep your coverage coverage for up to two years if:
  • You maintain a valid OHIP card.
  • You lived in Ontario for at least 153 days per year in the two years before departure.
• Reapplying for OHIP: If absent from Ontario for more than 212 days in a 12-month period, you may need to reapply for OHIP at a ServiceOntario center.

OHIP does not cover dental services, including:

1. Routine Dental Checkups

Routine dental visits help detect early signs of cavities, gum disease, and oral cancer, but OHIP does not cover these services. Individuals must pay out-of-pocket or secure private insurance.

2. Dental Cleanings

Preventative cleanings are crucial for maintaining healthy gums and preventing tooth decay, but they are not covered by OHIP.

3. Fillings and Tooth Extractions

Despite being common dental procedures, fillings and tooth extractions are not funded by OHIP.

4. Orthodontic Treatments

OHIP does not cover braces or aligners used to correct misaligned teeth or jaws, as these are considered elective procedures.

5. Cosmetic Dental Procedures

Procedures such as teeth whitening, veneers, and smile makeovers are classified as non-essential and are not included under OHIP.

If OHIP dental coverage is insufficient, Ontario offers additional government-funded programs:

1. Ontario Seniors Dental Care Program (OSDCP)

Launched in 2019, OSDCP provides free dental care to low-income seniors. Covered services include:

• Routine checkups
• Cleanings
• Fillings and extractions
• X-rays and root canals

Eligibility:

• Must be 65 years or older
• Must be an Ontario resident
• Individual income below $22,200 or household income below $37,100
• No existing dental coverage

OSDCP services are available through Public Health Units, Community Health Centres, and Aboriginal Health Access Centres.

2. Healthy Smiles Ontario (HSO)

HSO provides free dental care for children and teens (17 and under) from low-income families. Services include:

• Checkups
• Cleanings
• Cavity fillings
• X-rays
• Tooth extractions
• Fluoride treatments

Children whose families receive Ontario Works (OW) or Ontario Disability Support Program (ODSP) are automatically enrolled in HSO.

3. Canadian Dental Care Program (CDCP)

The Canadian Dental Care Program (CDCP) is a federally funded initiative aimed at improving access to essential dental care for millions of Canadians who do not have private dental insurance. This program is designed to reduce financial barriers to oral health services, ensuring that more people can receive the care they need to maintain good oral health and overall well-being.

What Does CDCP Cover?

The program provides coverage for a wide range of essential dental services, including:

• Routine checkups and examinations – Helping detect dental issues early.
• Professional cleanings – Removing plaque and tartar to prevent gum disease.
• X-rays – Assisting in diagnosing hidden dental problems.
• Cavity fillings – Restoring decayed or damaged teeth.
• Tooth extractions – Removing severely damaged or impacted teeth.
• Root canals – Treating infected teeth to prevent extractions.
• Preventative treatments – Such as fluoride applications and sealants for cavity prevention.

Additional services, such as dentures or orthodontics, may be covered depending on eligibility and clinical necessity.

Who is Eligible for CDCP?

To qualify for the CDCP, individuals must meet specific criteria, including:

• Canadian residency – The applicant must be a resident of Canada.
• Household income requirements – The program is intended for individuals and families whose annual income falls below a set threshold.
• No access to private dental insurance – Those covered by employer-based or personal dental insurance are not eligible.

How to Apply for CDCP?

Eligible individuals can apply through the Government of Canada’s official website, where they will need to provide proof of income and residency. Once approved, beneficiaries will receive coverage through participating dental care providers.

Why is CDCP Important?

Oral health is directly linked to overall health, and untreated dental problems can lead to serious conditions such as infections, cardiovascular disease, and diabetes complications. By making dental care more accessible, the CDCP aims to improve the quality of life for millions of Canadians while reducing long-term healthcare costs associated with poor oral health.

How long is the waiting period for OHIP dental coverage?

New Ontario residents and temporary foreign workers must wait three months before receiving OHIP benefits.

What does ‘OHIP for All’ mean?

This concept supports the idea that all Ontarians, regardless of immigration status, should have access to healthcare, including dental services.

Who is NOT eligible for OHIP dental coverage?

Those without valid identity documents (passport, birth certificate, etc.) cannot apply for an OHIP card. However, children of undocumented immigrants, as Canadian citizens, are entitled to OHIP benefits.