OHIP Dental Coverage and Free Dental Care Ontario in 2021

Posted by Dr. Joanne Baldos and Dr. Adam Szymczak on May 26, 2021 9:00:00 AM

Who gets OHIP Dental Coverage in Ontario?

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

 

The Ontario Health Insurance Plan (OHIP) covers ALL Ontario residents for medical procedures, however, the free dental care under OHIP is limited to oral surgery performed in a hospital and ONLY in 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 fall under 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. ( under rare circumstances and with prior approval by OHIP, tooth removal may fall under OHIP dental coverage)

 

Some hospitals have dental clinics, however, OHIP dental coverage does not apply to regular dental care.

 

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 2021

(in addition to OHIP Dental Coverage)

Free Dental Care Programs in Ontario in 2020

 

In addition to OHIP, there are 7 government-funded dental care programs in Ontario.

 

The 4 Ontario government-funded dental care programs are:

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 for low-income adults


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 cover emergency and regular dental care.

 

There are also 3 federal government-funded dental care programs (Government of Canada), which of course are available to Ontario residents as well:

5. (IFHP): Interim Federal Health Program:  free dental care for resettled refugees

6. (NIHB): Non-Insured Health Benefits: free dental care for eligible First Nations people

7. (VAC): Veterans Affairs Canada: free dental care for Canadian veterans

 

How do I qualify and apply for free dental care?

 

Each of the 7 free dental care programs has different criteria for qualifying and has separate processes to apply. Read below for details regarding each one of the programs:

 

 

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 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 the 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. 

 

OSDCP is not accessible through your regular dentist!

 

Who can get free dental care for seniors through the Ontario Seniors Dental Care Program (OSDCP)?

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

OSDCP should not be confused with OHIP dental coverage for seniors.

 

OHIP dental coverage for seniors is the same as for everyone else in Ontario. OHIP will cover  only for major jaw surgeries done in hospital.

 

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

There are 3 ways to apply:

 

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

 

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

 

3) 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 paperwork 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 (HSO)?

To apply for free dental care for kids 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 $24,129 or lower
    • 2 children household; household income must be $25,956 or lower
    • 3 children household; household income must be $27,782 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 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 paperwork 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
  • emergency dental services

 

 

3. (ODSP): Ontario Disability Support Program:

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

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

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

 

The ODSP provides basic dental services to ODSP recipients and their spouses:

  • exams
  • cleanings
  • fillings
  • root canals
  • tooth removal 

 

People who are eligible to receive Transitional Health Benefits are also eligible for this free dental care.

 

On April 1, 2019, the Ministry of Children, Community and Social Services (MCCSS) will no longer issue paper dental cards for adult ODSP recipients. Ontario dentists will need to register using the AccertaWorX online tool to verify patient eligibility for the ODSP dental program before providing dental care.

 

Dental Special Care Plan:

In addition to basic dental services, ODSP recipients and eligible spouses may receive
services under the Dental Special Care Plan which provides enhanced benefits for those whose dental needs result from disability, prescribed medications or medical treatment that affects oral health. For e
xample:

  • Radiation of head/ neck
  • Diuretics
  • Diabetes
  • HIV/AIDS
  • Developmental disabilities (such as Down Syndrome)


A dentist must apply for the Dental Special Care Plan on behalf of the patient by submitting a predetermination to Accerta which administers the ODSP dental benefit on behalf of MCSS. Dental Special Care treatment plans are valid for five years as long as the patient continues to be eligible for the ODSP dental benefit. Should the patient require additional services within the five-year period, a new pre-determination is required to authorize those services.

 

 

4. (OW): Ontario Works Dental Coverage:

( free dental care for low-income adults)

free dental care for low-income adults

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

 

Ontario Works (OW) provides income and employment support to people in temporary financial need.  

 

If you are receiving Ontario Works, you and your family may be eligible for certain health-related benefits.

To be eligible for Ontario Works, you must:

  • live in Ontario
  • need money right away to help pay for food and shelter, and
  • be willing to take part in activities that will help you find a job.

 

Two aspects to assess eligibility:

  • your financial situation, and
  • your willingness to take part in activities to find a job.

 

When you apply to Ontario Works, you will need to give information about:

  • family size
  • income
  • assets, and
  • housing costs.

Ontario Works staff will use this information to decide if you are financially eligible.

 

Ontario Works dental coverage includes basic diagnostic, preventive, restorative, endodontic, periodontal, prosthodontic, and oral surgery services. 

 

At their discretion, some municipalities offer emergency Ontario works dental coverage to adult OW recipients 18 years of age or older. Patients can contact their local Ontario Works office to determine if such a program is offered.

 

Contact Ontario Works office near you for further information as the benefit of basic dental care for low-income adults under OW is considered on a case by case basis. 

 

 

 

5. (IFHP): Interim Federal Health Program:

( free dental care for resettled refugees)

 

Refuges are issued IFHP certificates upon arrival in Canada at the point of entry.

 

IFHP is funded by the government of Canada through Citizenship and Immigration Canada.

 

The IFHP free dental care for refugees covers only initial services for emergency dental care. Only procedures to alleviate: infection, pain, bleeding and trauma are covered. 

 

Emergency examinations, dental x-rays, simple extractions, and getting a prescription are covered. Denture relines and repairs are also covered.

 

Complicated extractions, fillings, new dentures and general anesthesia may be covered but need to be pre-approved.

 

Routine dental care is not covered:

  • dental cleanings (scaling, polish), fluoride and check-ups
  • root canals
  • orthodontics
  • sedation
  • pulpotomies and stainless steel crowns

IFHP is meant for short-term use, a period of eligibility up to 12 months, to help a refugee who is not eligible for provincial health insurance. IFHP does not cover services that a person can claim under a private insurance plan.

 

 

6. (NIHB): NON-INSURED HEALTH BENEFITS:

( free dental care for eligible First Nations people and Inuit)

 

The federal government's department of Health Canada funds the Non-Insured Health Benefits Program (NIHB) which includes free dental care.

 

To be eligible for NIHB, one must be a Canadian resident and be one of:

  • registered as an Indian according to the Indian Act
  • Inuit Land Claim organization recognized Inuk
  • a child (under 12 months old) whose parent is eligible for NIHB


If a person has multiple sources of dental coverage such as private dental care plan, public or social dental program, claims must be submitted to these plans first before submitting them to NIHB.

 

NIHB does cover most dental treatments: 

  • dental examinations
  • dental x-rays
  • cleanings
  • dental fillings
  • root canals
  • removable dentures
  • removal of teeth
  • braces
  • general anesthetic or sedation

To be sure that the treatment planned is covered under NHIB, it's best that the dentist first submits for a pre-approval for treatment to:

 

National Dental Predetermination Centre
Non-Insured Health Benefits
First Nations and Inuit Health Branch, Health Canada
Address Locator 1902D, 2nd Floor, Jeanne Mance Building
200 Eglantine Driveway
Ottawa, ON K1A 0K9
Toll-Free Phone Number: 1-855-618-6291
Toll-Free Fax Number: 1-855-618-6290

 

 

7. (VAC): Veterans Affairs Canada:

( free dental care for Canadian veterans)

 

People who served in the Canadian military may be eligible for free dental care if they are:

 

VAC provides 100% coverage for basic dental care up to $1500 annually for:

  • dental cleanings (up to 8 units per year = 2 hours of cleaning per year)
  • check-ups, polish and fluoride treatments every 9 months
  • fillings
  • extractions
  • dentures once every 7 years

Comprehensive dental services require a pre-authorization from VAC:

  • basic treatment exceeding $1500 annually
  • crowns
  • early replacement of dentures as determined by your dentist or denturist

 

 

SUMMARY: OHIP and Free Dental Care

 

OHIP Dental Coverage and Free Dental Care Ontario in 2020

In Ontario there are 8 government-funded dental care 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
  6. (IFHP): Interim Federal Health Program:  free dental care for resettled refugees
  7. (NIHB): Non-Insured Health Benefits: free dental care for eligible First Nations people
  8. (VAC): Veterans Affairs Canada: free dental care for Canadian veterans

 

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

 

Most people that have dental coverage in Ontario have private insurance provided by their employer.

 

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 is sponsored by the same 8 programs since these programs are sponsored by the Ontario government and the Government of Canada.

 

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

 

FAQ about OHIP Dental Coverage and Free Dental Care in Ontario

 

Does OHIP cover dental?

Generally speaking, OHIP does not cover dental care. The exceptions are complex jaw bone surgeries such as tumour removal, fracture repairs and jaw reconstruction. In extremely rare cases and with prior approval by OHIP, tooth removal may be covered under OHIP. Even though OHIP dental coverage is limited, there are 7 other programs in Ontario that do provide a wide range of dental services for free.

 

Does OHIP cover dental for seniors?

In Ontario, free dental care for low-income seniors is administered through the Ontario Seniors Dental Care Program (OSDCP) NOT through OHIP. Launched on Nov.20, 2019, OSDCP aims to deliver regular dental services for low-income seniors. OHIP dental coverage for seniors is the same as for everyone else in Ontario: only for major surgeries done in hospital.

 

Will OHIP cover dental surgery?

OHIP does cover surgeries of the jaws but does not cover dental care. If your jaw bone  is fractured, if your jaw bone has a tumour, if your jaw bone has a defect and the dental surgery is performed in the hospital then it will be covered by OHIP.

 

What do I do if I can't afford a dentist?

If you can not afford a dentist, first find out if you qualify for one of the 8 free dental care programs administered by the government: OHIP, OSDCP, HSO, ODSP, OW, IFHP, NIHB, and VAC. If you do not qualify for free dental care under one of these programs, then your next step in finding affordable dental care should be to understand the difference between dentist prices and dental costs, it will help you find a reasonably priced dentist.

 

Free dental implants in Canada?

There is no such thing as free dental implants in Canada. The only way to get free dental care in Canada is to have the government pay for the dental care and none of the government-funded programs cover dental implants.

 

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

Dr. Joanne Baldos and Dr. Adam Szymczak

 

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