OHIP Dental Coverage and Free Dental Care Ontario in 2020

Posted by Dr. Joanne Baldos and Dr. Adam Szymczak on Jan 16, 2020 8:48:28 PM

Who gets OHIP Dental Coverage in Ontario?

OHIP dental coverage is a type of free dental care in Ontario for Ontario residents.

Ontario Health Insurance Plan (OHIP) covers ALL Ontario residents, however, the free dental care is limited to oral surgery performed in a hospital and ONLY in extreme and limited situations such as:

  • correcting birth defects (eg.cleft-lip and palate)
  • surgery for diseases of the jaw (eg. cysts and tumours)
  • correcting damage to the jaws and face as a result of an accident (eg. fractured jaw)

 

Most people think of the above services as medical OHIP services, but in fact they are OHIP dental coverage as it is dentists that provide those treatments and OHIP is billed for those services.

 

OHIP dental coverage does NOT include regular dental care such as: checkups, cleanings, fillings, x-rays, root canals and tooth removal. 

 

Some hospitals have dental clinics, however, OHIP dental coverage does not apply. For regular dental care, a hospital based dental clinic will charge you the same way as a private dental clinic.

 

 

Free Dental Care Programs in Ontario in 2020

(in addition to OHIP Dental Coverage)

Free Dental Care Programs in Ontario in 2020

 

The Ontario government sponsors 4 additional programs for free dental care:

  1. (OSDCP): Ontario Seniors Dental Care Program: free dental care for seniors in Ontario
  2. (HSO): Healthy Smiles Ontario: free dental care for kids
  3. (ODSP): Ontario Disability Support Program: free dental care for adults that are disabled
  4. (OW): Ontario Works: free dental care

 

Unlike OHIP dental coverage which you access automatically using your OHIP card, to qualify for the above free dental programs you need to apply first. These programs do cover emergency and regular dental care.

 

How do I qualify and apply for free dental care?

 

Each of the 4 free dental care programs have different criteria for qualifying and have separate processes to apply.

 

1. (OSDCP): Ontario Seniors Dental Care Program:

(free dental care for seniors in Ontario)

Ontario Seniors Dental Care Program: free dental care for seniors in Ontario

 

On Nov.20, 2019 the the Ontario government officially launched the Ontario Seniors Dental Care Program (OSDCP) which aims to deliver regular dental services for low income seniors.

 

The government was motivated by 2 facts to commit $90 million every year to OSDCP:

  • every year there are over 60,000 emergency HOSPITAL visits for infection and pain as a result of PREVENTABLE dental conditions such as gum disease and tooth decay
  • lack of regular dental care has a significant effect on overall health and quality of life

 

The government hopes this program will cut emergency hospital wait times and improve overall well-being of seniors by providing regular dental care such as: checkups, cleanings, fillings, x-rays, root canals and tooth removal. (dentures will be covered partially)

 

The dental services will be provided through Public Health Units, some Community Health Centres and Aboriginal Health Access Centres. This is unlike the other 3 free dental care programs which are delivered by participating private dental clinics.

 

Who can get free dental care through the Ontario Seniors Dental

Care Program?

To qualify for OSDCP you must:

      • be at least 65 years old
      • be an Ontario resident
      • have an annual income of $19, 300 or less (single person); for a couple: combined annual income of $32,300 or less
      • NOT have other dental benefits

 

How do I apply for the Ontario Seniors Dental Care Program?

There are 3 ways to apply:

 

A) Pick up an application from your local public health unit.

 

B) Download and print the application: HERE. ( you will need Adobe Acrobat Reader version 10.0 or higher)

 

C) Complete the “online application form”. In addition to filling out the “online application" you will still need to print, sign and mail in the consent section of the application.

 

Complete the paper work and mail the documents to:

 

Ministry of Health
Ontario Seniors Dental Care Program
Station P, P.O. Box 159
Toronto, ON

M5S 2S7

 

Once the application is approved, you will receive a Healthy Smiles Ontario dental card in the mail. If there is a problem with your application you will be contacted by phone and/or mail.

 

2. (HSO): Healthy Smiles Ontario:

(free dental care for kids)

Healthy Smiles Ontario: free dental care for kids

 

What is Healthy Smiles Ontario?

Healthy Smiles Ontario is free dental care for kids and youth 17 years old and younger.

 

Healthy Smiles Ontario was created on Jan.1, 2016 by combining multiple publicly funded free dental care programs, namely:

    • Ontario Works dental benefits for kids
    • Ontario Disability Support Program dental benefits for kids
    • Assistance for Children with Severe Disabilities dental benefits program
    • ( CINOT) Children in Need of Treatment
    • Preventive services provided by local public health units

 

Does Healthy Smiles Ontario Cover Braces?

Healthy Smiles Ontario does NOT cover braces. It also does not cover other cosmetic services such as veneers and teeth whitening. Dental implants are also not covered.

 

How do I apply for Healthy Smiles Ontario?

To apply for free dental care under HSO, your child must:

  • be 17 years old or younger
  • live in Ontario
  • live in a low income household:
    • 1 child household; household income must be $23,680 or lower
    • 2 children household; household income must be $25,472 or lower
    • 3 children household; household income must be $27,265 or lower

 

Kids 17 and under are automatically enrolled in Healthy Smiles Ontario when they or their family receive: Ontario Works, Temporary Care assistance, Assistance for Children with Severe Disabilities or the Ontario Disability Support Program.

 

A child who has dental insurance coverage CAN apply and be eligible for HSO as long as the above criteria are met.

 

There are 3 ways to obtain an application and apply:

 

A) Pick up an application from your local public health unit or from a Service Ontario location.

 

B) Download and print the application: HERE.

( you will need Adobe Acrobat Reader version 10.0 or higher)

 

C) Complete the “online application form”.

In addition to filling out the “online application" you will still need to print, sign and mail in the consent section of the application.

 

Complete the paper work and mail the documents to:

Healthy Smiles Ontario
33 King Street West
PO Box 645
Oshawa, ON
L1H  8X1

 

Once your application is approved, you will receive a dental card in the mail. If there is a problem with your application you will be contacted by phone and/or mail.

 

What does Healthy Smiles Ontario cover?

Healthy Smiles Ontario covers regular dental care such as:

        • checkups
        • cleanings
        • fillings
        • x-rays
        • root canals
        • tooth removal
        • gum surgery
        • some tooth replacement options
        • sedation and emergency dental services

 

3. (ODSP): Ontario Disability Support Program:

( free dental care for adults that have a substantial physical or mental disability)

 

Speak to your ODSP caseworker for details about eligibility as the benefit of basic free dental care under ODSP is discretionary.

 

Children of parents receiving ODSP will be automatically enrolled in Healthy Smiles Ontario: free regular dental care for kids.

 

4. (OW): Ontario Works:

( free dental care for adults that live in poverty)

 

Contact Ontario Works office near you for further information as the benefit of basic free dental care under OW is discretionary.

 

Children of parents receiving OW will be automatically enrolled in Healthy Smiles Ontario: free regular dental care for kids.

 

SUMMARY: OHIP and Free Dental Care

 

OHIP Dental Coverage and Free Dental Care Ontario in 2020

Free Dental Care Ontario exists under 5 separate Ontario government sponsored programs:

  1. OHIP Dental Coverage: free dental care for all Ontario residents, but only in extreme dental/ medical situations.
  2. (OSDCP): Ontario Seniors Dental Care Program: free dental care for seniors in Ontario with low income
  3. (HSO): Healthy Smiles Ontario: free dental care for kids from low income households
  4. (ODSP): Ontario Disability Support Program: free dental care for adults that are disabled
  5. (OW): Ontario Works: free dental care for low income adults

 

With the exception of the above programs, free dental care for adults in Ontario does not exist.

 

Most people that get dental care have dental insurance paid for by their employer or pay out of pocket for dental services.

 

The free dental programs cover those most at risk of neglect: our seniors, our children and the poor.

 

Free dental care in Toronto or any other city in Ontario are sponsored by the same 5 programs since these programs are Ontario government based.

 

If you do not qualify for Free Dental Care, then your next step in Finding Affordable Dental Care is to understand the difference between Dentist Prices and Dental Costs.

 

In the best interest of your health and well-being,

Dr. Joanne Baldos and Dr. Adam Szymczak

 

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