Income tiers and co-payments
Your adjusted family net income does two jobs in the CDCP: it decides whether you qualify at all, and it decides what share of the bill the plan pays. There are three tiers, and the percentages apply to the CDCP's established fees — not to whatever your provider normally charges.
| Adjusted family net income | CDCP pays | Your co-payment |
|---|---|---|
| Under $70,000 | 100% of CDCP fees | 0% |
| $70,000 to $79,999 | 60% of CDCP fees | 40% |
| $80,000 to $89,999 | 40% of CDCP fees | 60% |
| $90,000 or more | Not eligible | Not applicable |
These tiers were confirmed against Canada.ca on 25 October 2026. They are the current published tiers; if a future budget changes them, Canada.ca will show the new table, and this page's figures would need updating.
Worked examples
Each example below uses the same stated assumptions, so you can compare tiers fairly. Assumptions: the treatment is a covered service, no preauthorization issue arises, and the provider charges exactly the CDCP established fee. Where a provider charges more, add the difference to every figure below.
| Example | CDCP fee | Tier | CDCP pays | You pay |
|---|---|---|---|---|
| A filling | $200 | Under $70,000 | $200 | $0 |
| A filling | $200 | $70,000–$79,999 | $120 | $80 |
| A filling | $200 | $80,000–$89,999 | $80 | $120 |
| Scaling and exam | $350 | Under $70,000 | $350 | $0 |
| Scaling and exam | $350 | $70,000–$79,999 | $210 | $140 |
| Scaling and exam | $350 | $80,000–$89,999 | $140 | $210 |
The fee gap: the part people miss
Now change one assumption. Suppose the filling above has a CDCP fee of $200, but your clinic's regular fee is $260. In the middle tier, the CDCP pays 60% of $200, which is $120. You pay the 40% co-payment ($80) plus the $60 gap between the clinic's fee and the CDCP fee — $140 in total, not $80. In the lowest tier, you would pay $0 co-payment but still owe the $60 gap. This is why the question "What will I owe after the CDCP pays?" matters more than the tier table alone. Some clinics charge exactly the CDCP fee; many do not. Ask for a written estimate before treatment, and ask whether the clinic will charge above the CDCP fee.
What else can you owe?
- Services the plan does not cover: you pay the full cost if you and your provider agree to a non-covered service.
- Services over frequency limits: some services are covered only up to a set frequency; beyond that, you pay.
- Treatment without required preauthorization: if approval was needed and not obtained, the plan may not pay.
There is no premium and no annual maximum in the usual insurance sense
You do not pay a monthly premium to join the CDCP. Your costs are the co-payment, any fee gap, and any non-covered services. That is different from private insurance, which usually has premiums, deductibles, and an annual maximum payout. Do not compare a CDCP co-payment directly with a private plan's co-insurance without checking what each plan actually covers.
Photo credits: de10.jpg — Money box (CC BY 4.0); de11.jpg — Calculator (CC BY-SA 3.0); de12.jpg — Piggy bank container (CC BY-SA 3.0) All photos via Wikimedia Commons under the licences noted.