Ottawa says those with dental coverage are ineligible but the rules are less clear on dropping existing plans

Eligible seniors are now receiving letters inviting them to sign up for Canada’s $13 billion national dental care plan — but there’s a catch.

Those who currently have private dental insurance do not qualify for the national plan.

And according to a government website explaining the plan, anyone who opts out of “available benefits” is “still considered to have access to dental insurance.”

That seems to mean that switching from a private plan to the public plan isn’t permitted. But the federal health minister’s office has yet to clarify the rule.

The uncertainty has seniors with minimal private dental coverage, or those who purchased plans themselves, wondering whether they’re being left behind.

“There’s double standards,” said 71-year old Richard McDonald-Donaldson, who has been paying $180 a month for a private insurance plan he purchased.

Starting in May, Canadian residents 65 and older in households that make under $90,000 annually will be able to get some or all of their routine dentistry paid for through the Canadian Dental Care Plan. Work like scalings, fillings, root canals and dentures will be covered.

But you can’t qualify for the new national plan if you have existing private dental care insurance through your employer, your pension or any other organization, or through a plan you’ve purchased yourself.

“I thought, well, maybe I’ll just drop my dental plan. It costs me a fortune. And then I’ll qualify,” McDonald-Donaldson said. “But apparently not so.”

McDonald-Donaldson said it doesn’t feel right that seniors like him should be compelled to go on paying for private coverage.

“The rules seem to prejudice the guy that went and made the effort to try and buy his own insurance to save a bit of problems later on with his teeth,” he said.

“There’s something wrong with that system.”

CBC News has heard from many seniors wondering what would happen if they left their existing dental plans and sought to join the public one.

CBC News asked Health Canada and the office of Health Minister Mark Holland to explain how dropping out of an existing private insurance plan would affect an individual’s eligibility for the national dental care plan, but did not receive a response.

“The Canadian Dental Care Plan is intended to help the almost nine million Canadians who do not have any access to dental insurance,” a statement from Holland’s office said.

St. Thomas, Ont. retiree Doug Carter has a small amount of dental coverage through his former employer, a plan he said reimburses him only for basic dental care at the rate the procedures cost in 1988. He said he needs a tooth replaced but his insurance won’t cover it.

“It really makes me think, what am I going to do? Four thousand dollars is a lot to be out of pocket,” Carter said.

“I don’t think it’s fair because, if you’re having next to nothing in coverage, it’s just taking a whole section of people and saying, ‘We don’t care.'”

Seniors should be allowed the option of dropping their private insurance plans for the national one, Carter said, “if the plan they have is pretty bad … In this case, this one is.”

Ottawa needs to explain the rules, expert says

An expert in dental care programs says Ottawa needs to provide answers.

“The policy approach may not completely cover off all the situations that are at play here,” said Dr. Carlos Quiñonez, director of dentistry at Western University in London, Ont.

“Could it be that I can give up my plan, and then there’s a waiting period that I would have to respect before I can then gain coverage through the federal plan?

“These are important questions that need to be clarified.”

Quiñonez said if the intention is to reduce financial barriers to dental care, Ottawa should look at the problem of “under-insurance” — of people with minimal private dental plans who lack the means to pay for necessary work their plans don’t cover.

Still, any government plan is going to need set limits and rules in order to work within its allocated funds, which inevitably will leave some people behind, Quiñonez said.

“There will always be winners and losers. I know that doesn’t sound kind, but that is the reality of the matter,” he said.

For now, Quiñonez said he’s advising seniors to hang on to their current private dental insurance plans until the federal government offers more clarity.