PolicyMe’s Andrew Ostro says Canada’s dental care plan must integrate with private plans rather than force plan sponsors to choose one or the other
The Canadian Dental Care Plan (CDCP) has expanded access to oral health care for millions of Canadians, but a rigid eligibility design and limited coverage are leaving many enrolled members worse off than they expected.
As a result, this is putting employers between a rock and a hard place, according to Andrew Ostro, CEO and co-founder of Toronto-based PolicyMe.
The Canadian Dental Association (CDA)’s inaugural assessment of the CDCP, From Coverage to Care, found that enrollment fell from 6.5 million in 2025–26 to 4.7 million in 2026–27, and only 900,000 members have had a claim approved so far this year while 59 per cent of enrollees expected their care to be free.
Canadians reporting no dental coverage has dropped from 35 per cent to 25 per cent since the plan launched, but 37 per cent of those with CDCP coverage still report financial barriers to care, the CDA found.
Ostro said the CDA’s inaugural findings align with his early concerns about the plan’s structure. While fewer Canadians lack dental coverage than before the program launched - and he credits the CDCP for that progress – he noted a steep drop-off between enrollment and actual use points to a deeper problem.
“There’s still a lot of people who are enrolled but not getting coverage or aren’t getting as much coverage as they thought they were getting or there’s confusion around what’s covered and what’s not covered,” he said. “Even people who are enrolled aren’t getting much out of it. I think there's still a lot of work to do to still, but we're certainly on the right track.”
Copays, fee limits compound the CDCP coverage gap
Ostro sees the CDCP’s copay structure as a central problem because only households earning below $70,000 receive full coverage. As income rises toward the $90,000 threshold, the government’s share drops to 60 per cent or even 40 per cent – meaning some enrollees are paying more than half the bill out of pocket, which in many cases is worse than what a modest employer plan would have covered, Ostro suggests.
Still, the copay is only one layer as the CDCP also caps what it will pay for each procedure, and those prescribed limits often fall well below what dentists charge. Dental practices are private businesses that set their own fees within professional guidelines, and there is nothing unusual about a provider billing $300 for a procedure the CDCP values at $200, for example.
Once the copay split is applied to the lower government figure, the patient can end up covering the vast majority of the cost. In Ostro’s example, the enrollee pays $220 and the government pays $80.
“Even the people who are covered and eligible can still face some pretty significant out-of-pocket expenses,” he said, adding that combined with the eligibility rule that is prompting some employers to drop dental coverage altogether, the net effect is that a meaningful number of Canadians may be worse off under the CDCP than they were before the program existed.
Additionally, Ostro believes the CDCP treats public and private dental coverage as mutually exclusive. Rather than allowing Canadians to supplement an employer plan with federal support – the way provincial health coverage works alongside private benefits – the CDCP disqualifies anyone who has been offered group dental through work.
Any worker who’s offered dental coverage through an employer, even if that coverage is inferior to the CDCP, and even if the worker declines it, is automatically disqualified from the federal plan.
The disqualification applies regardless of quality. A worker whose employer offers minimal dental coverage cannot opt for the CDCP instead, even if the federal plan would provide more. Simply being offered the benefit is enough to lock someone out, Ostro said.
Why offering group dental can backfire under the CDCP
That, in turn, puts employers in a bind. Providing dental coverage – at the employer’s own cost – can inadvertently strip workers of access to a more generous public program.
“As a result, there's a lot of discussion from plan sponsors around, ‘Do I cancel it? Do I not cancel it? Do I get any value out of it?’ That often leads to everyone else being worse off. I think there's a lot of work to do here on thinking through how private plans, dental plans, and the CDCP play together and interact with one another versus one or the other,” said Ostro.
“Now, look, there's a lot of people who didn't have employer coverage, and this is better than nothing. And I don't want to make it seem like everyone is worse off here because there's a significant amount of people who are much better off with this than without. The goal shouldn't be, people are better, some are worse, we're done. It's to continue to chip away and figure out how to make more people better off with this program,” he added.
The case for making private and public plans work together
Despite the CDA calling for public coverage to remain complementary to existing private plans rather than replace them, Ostro suggests the CDCP in its current form poses little threat to the private insurance market.
For Canadians who can afford individual plans, private coverage still delivers better value than the federal program. The real problem is the population caught in the middle - people who earn too much to get meaningful CDCP support but not enough to comfortably purchase private coverage on their own.
He dismissed the idea that Ottawa would ever expand the CDCP into a universal public dental system modelled on provincial health care. No one in the industry considers that realistic, he said, and it is not what the CDA or private insurers are asking for. The goal is integration, not replacement, he said.
He compared the current structure to how Canadians think about retirement income.
“You have the government plans, you have your employer plans, and you have your personal savings, and those all work together to help you think about your retirement. And that’s what we’re suggesting needs to happen for dental,” he said, underscoring better coordination between public and private coverage would not shrink the private market. Rather, he believes it would strengthen it in the same way supplemental health benefits support rather than compete with provincial plans.
Dental coverage tops the benefits wish list
Recent survey data underscores the demand. Robert Half found that dental coverage outranks hybrid work on Gen Z’s benefits wish list, placing second only to flexible scheduling among the perks young workers weigh when evaluating job offers. Ostro believes dental remains the benefit employees care about most, ahead of vision and drug coverage, because the financial exposure is higher and less predictable.
“The single biggest thing the CDCP can do to improve is figure out how to interact with private plans, either group plans through your employer or individual plans you buy yourself, versus making it one or the other,” he said. “As it’s structured right now, they don’t work together, and it creates a lot of confusion and complexity and most importantly, gaps.”
