What Does ODSP Cover for Dental in Ontario?
ODSP provides dental benefits to adult recipients and their spouses, and it covers essential dental care set out in the Government of Ontario's dental schedule. That generally includes exams, x-rays, cleanings, fillings, root canals, gum treatment, and extractions, subject to frequency limits. For services that are covered, you cannot be charged the difference, so covered care is at no cost to you.
Here is a plain-language guide to what ODSP dental covers, what it does not, and how to use it at a dentist in Hamilton.
Who ODSP dental benefits are for
ODSP dental benefits are available to ODSP recipients and their spouse who is 18 or older. A few points are worth knowing:
- Children 17 and under, and a spouse under 18, are covered through Healthy Smiles Ontario rather than ODSP.
- Dependent adults, meaning dependants 18 or older who are not the recipient's spouse, are not eligible for ODSP dental. They may receive discretionary dental care through Ontario Works, usually for emergencies or dentures.
- Former recipients receiving the Extended Health Benefit or the Transitional Health Benefit remain eligible for dental benefits.
What ODSP dental covers
The services, fees and limits are set out in the Government of Ontario's dental schedule, which Accerta administers on behalf of the Ministry of Children, Community and Social Services. In plain terms, ODSP dental focuses on essential care, which generally includes:
Exams and check-ups
Routine and emergency exams to monitor your oral health.
X-rays
Diagnostic images that help catch problems early.
Cleanings and scaling
Removing plaque and tartar, plus fluoride where the criteria are met.
Fillings
Repairing cavities and minor tooth damage.
Root canals
Endodontic treatment to save an infected or damaged tooth.
Gum (periodontal) treatment
Care for gum disease and the tissues around your teeth.
Extractions and oral surgery
Removing teeth that cannot be saved, including some surgical extractions.
Sedation where required
Anaesthesia or sedation when a procedure calls for it.
You pay nothing for covered services
For services that are covered and paid under the ODSP schedule, extra billing and balance billing are not permitted, so you are not charged the difference. You may only be charged for services that are not covered, and we always explain any of those before treatment begins.
How frequency limits work
ODSP sets frequency limits on many services. For example, the schedule covers up to two exams in a 12-month period. The exact services and their limits are set by the provincial schedule, so it is worth asking your dentist what applies to your situation before treatment.
Extra coverage: the Dental Special Care Plan
If your disability, prescribed medications or prescribed medical treatment affects your oral health, you may qualify for additional services under the Dental Special Care Plan. Qualifying situations include head or neck radiation, diuretics, diabetes, HIV/AIDS, and developmental disabilities such as Down Syndrome.
Your dentist applies on your behalf by submitting a pre-determination to Accerta, and an approved plan is valid for five years while you remain eligible.
What ODSP dental does not cover
Not included in the dental schedule
ODSP dental does not cover cosmetic treatments such as teeth whitening and veneers, or dental implants. Dentures are handled through a separate denture program rather than the main dental schedule. You can read more in our guide to whether ODSP covers dentures.
How to use your ODSP dental benefit
- Bring your ID. Bring your Ontario health card, or another accepted piece of government identification such as your statement of assistance or driver's licence. A paper dental card is no longer issued routinely.
- We verify your coverage. The office confirms your eligibility through the AccertaWorX Dental Portal, the tool Accerta uses to administer the ODSP dental benefit for the ministry.
- We confirm what is covered. Before any treatment, we tell you what is covered and flag anything that is not.
One tip the province itself gives patients is to make sure your dental office participates in the ODSP Dental Plan, because not every office does. Ours does, and we are accepting new ODSP patients in Hamilton.
ODSP and the Canadian Dental Care Plan
Many people on ODSP also qualify for the Canadian Dental Care Plan (CDCP). If you have both, the CDCP is the primary payer and, at clinics that coordinate benefits, ODSP can top up part of the rest. Applying for the CDCP does not affect your ODSP income support.
Learn more in our guide to moving from ODSP to the CDCP, or see the full comparison of ODSP, Ontario Works and the CDCP.
Looking for a Hamilton dentist who accepts ODSP?
We are accepting new ODSP patients at our ground-floor clinic inside Jackson Square Mall. We will verify your coverage and explain what is included before any treatment.
ODSP dental coverage, frequently asked questions
Sources
- Government of Ontario, ODSP policy directive 9.7 Dental benefits
- Government of Ontario, ODSP health and disability benefits
- MCCSS Schedule of Dental Services and Fees (administered by Accerta)
