It’s easy to be confused about what the CDCP covers. It is a new program that both patients and dentists are working under so we are all learning about it together. The CDCP does cover braces, implants, and sedation but many of those services must be preauthorized before a patient can be treated.
The program offers coverage for an incredible number of services. The only services that aren’t covered are cosmetic dentistry services. However, some of those services like dental implants also fall under mouth restoration, which is covered. This is why a preauthorization is required before your appointment.
Orthodontics Set to be Covered in 2025
Orthodontic services haven’t been covered by the CDCP since it was introduced in 2023 but this group of services will be included in coverage this year. That doesn’t mean everyone can get braces or clear aligners.
Orthodontic services will be covered only in cases of medical need. That means, in general terms, that misaligned teeth are causing problems with chewing, TMJ, or some other medical issue. The criteria will be strict and preauthorization is required.
Important: Spending on orthodontics will be limited so expect only the basic services to be included in the plan. Basic services include items like traditional metal braces but likely will not include clear ceramic braces or the more expensive clear aligners.
Implants Could Be Covered
Implants also fall into a grey area because they replace missing teeth but could be considered cosmetic. They require preauthorization but the CDCP covers posts, cores, and crowns under restorative services. Post and crown repair or removal don’t require a preauthorization. Crown, core, or post installation requires pre-authorization.
Much of whether a service is approved during pre-authorization relies on your dentist and their office staff. They must frame the request to show these services are medically necessary rather than for cosmetic purposes to get approval. That comes down to the exam and the conversation you have with your dentist about your oral health care needs and options.
Anesthesia and Sedation Is Covered
The CDCP will pay for all types of anesthesia and sedation but most require pre-approval. Local anesthesia used for most medical services is always covered without pre-authorization and part of the dental service.
Conscious anesthesia, which is typically nitrous oxide (laughing gas), doesn’t require pre-approval if it is minimal. Sedation that falls into the moderate, deep, or general anesthesia categories always requires pre-approval. That includes methods like oral and IV.
How Do I Know If My Service is Covered?
The CDCP website gives some great information on what is covered and what is needed for coverage. The only way to know for sure if your dental service is covered is to have your dentist office request pre-authorization. We will do the paperwork and guide you through the process.
How Long Does It Take to Get Pre-Approval?
The time varies and depends on the amount of intake the CDCP has and the complexities of your case. The best scenario for pre-approval for a dental service is that it will take several weeks to get it. You shouldn’t put off requesting pre-approval as it will take time to work through the system.
More Questions?
We are happy to answer questions about how we work with the CDCP to provide dental care. Our staff can navigate you through the process so that you can apply and get the dental services you need.
