Explore 2024 Tufts Health Plan Medicare Supplement Dental Coverage
Tufts Health Plan Medicare Supplement Dental Coverage
2024 Tufts Health Plan Medicare Supplement Dental Coverage buy up option provides complete dental coverage including a $0 deductible, $0 preventive services such as cleanings and oral exams, 20% coinsurance for restorative services such as fillings and simple extractions, and 50% coinsurance for comprehensive services such as dentures, bridges, and crowns. Plus, you have the ability to see any licensed dentist, as you are not limited to a network. View your Evidence of Coverage for complete coverage details.
Medicare Supplement Dental Benefit Essentials
| Benefit |
With Purchased Medicare Supplement Dental Option |
|
|---|---|---|
| Premium (Per Month) |
With Purchased Medicare Supplement Dental Option |
$33.00 |
| Or | ||
| Calendar Year Maximum |
With Purchased Medicare Supplement Dental Option |
$1,000 |
| Or | ||
| Deductible |
With Purchased Medicare Supplement Dental Option |
$0 |
| Or |
Class I
Member Cost Share for Diagnostic & Preventative Services
Diagnostic & Preventative Services
| Benefit |
With Purchased Medicare Supplement Dental Option |
|
|---|---|---|
| Comprehensive oral exam; including the initial dental history and charting of teeth. |
With Purchased Medicare Supplement Dental Option |
$0 |
| Or | ||
| Periodic oral evaluation |
With Purchased Medicare Supplement Dental Option |
$0 |
| Or | ||
| Intra oral bitewing X-ray images (X-rays of the crowns of the teeth) when oral conditions indicate need |
With Purchased Medicare Supplement Dental Option |
$0 |
| Or | ||
| Prophylaxis (routine cleaning, scaling, and polishing of teeth) |
With Purchased Medicare Supplement Dental Option |
$0 |
| Or |
Class II
Member Cost Share for Basic Services
Basic Services
| Benefit |
With Purchased Medicare Supplement Dental Option |
|
|---|---|---|
| Emergency oral evaluation problem focused exams Once every 12 months. |
With Purchased Medicare Supplement Dental Option |
20% coinsurance |
| Or | ||
| Intra oral X-ray image of the entire mouth (panoramic image) |
With Purchased Medicare Supplement Dental Option |
20% coinsurance |
| Or | ||
| Intra oral X-ray image of the entire mouth (full mouth series) |
With Purchased Medicare Supplement Dental Option |
20% coinsurance |
| Or | ||
| Single tooth X-ray images |
With Purchased Medicare Supplement Dental Option |
20% coinsurance |
| Or | ||
| Silver fillings and white fillings |
With Purchased Medicare Supplement Dental Option |
20% coinsurance |
| Or | ||
| Periodontal cleaning |
With Purchased Medicare Supplement Dental Option |
20% coinsurance |
| Or | ||
| Scaling and root planing |
With Purchased Medicare Supplement Dental Option |
20% coinsurance |
| Or | ||
| Scaling in presence of generalized moderate/severe gingival inflammation |
With Purchased Medicare Supplement Dental Option |
20% coinsurance |
| Or | ||
| Full mouth debridement |
With Purchased Medicare Supplement Dental Option |
20% coinsurance |
| Or | ||
| Simple Extractions |
With Purchased Medicare Supplement Dental Option |
20% coinsurance |
| Or | ||
| Minor treatment for pain relief |
With Purchased Medicare Supplement Dental Option |
20% coinsurance |
| Or |
Class III
Member Cost Share for Major Restorative Services
Protective Restorations & Oral Surgery
| Benefit |
With Purchased Medicare Supplement Dental Option |
|
|---|---|---|
| Protective Restorations |
With Purchased Medicare Supplement Dental Option |
50% coinsurance |
| Or | ||
| Surgical extractions |
With Purchased Medicare Supplement Dental Option |
50% coinsurance |
| Or |
Periodontics
| Benefit |
With Purchased Medicare Supplement Dental Option |
|
|---|---|---|
| Periodontal surgery |
With Purchased Medicare Supplement Dental Option |
50% coinsurance |
| Or | ||
| Bone grafts and guided tissue regeneration
|
With Purchased Medicare Supplement Dental Option |
50% coinsurance |
| Or |
Endodontics
| Benefit |
With Purchased Medicare Supplement Dental Option |
|
|---|---|---|
| Root canal treatment |
With Purchased Medicare Supplement Dental Option |
50% coinsurance |
| Or | ||
| Retreatment root canal therapy |
With Purchased Medicare Supplement Dental Option |
50% coinsurance |
| Or | ||
| Apicoectomy |
With Purchased Medicare Supplement Dental Option |
50% coinsurance |
| Or |
Prosthetic Maintenance
| Benefit |
With Purchased Medicare Supplement Dental Option |
|
|---|---|---|
| Bridge or denture repair |
With Purchased Medicare Supplement Dental Option |
50% coinsurance |
| Or | ||
| Tissue conditioning |
With Purchased Medicare Supplement Dental Option |
50% coinsurance |
| Or | ||
| Adding teeth to existing partial or full dentures |
With Purchased Medicare Supplement Dental Option |
50% coinsurance |
| Or | ||
| Rebase or reline of dentures |
With Purchased Medicare Supplement Dental Option |
50% coinsurance |
| Or |
Adjunctive Services
Provided in conjunction with the primary treatment.
| Benefit |
With Purchased Medicare Supplement Dental Option |
|
|---|---|---|
| Local anesthesia and inhalation of nitrous oxide/analgesia, anxiolysis |
With Purchased Medicare Supplement Dental Option |
50% coinsurance |
| Or |
Prosthodontics
| Benefit |
With Purchased Medicare Supplement Dental Option |
|
|---|---|---|
| Dentures (complete or partial dentures) |
With Purchased Medicare Supplement Dental Option |
50% coinsurance |
| Or | ||
| Fixed bridges |
With Purchased Medicare Supplement Dental Option |
50% coinsurance |
| Or | ||
| Temporary partial dentures |
With Purchased Medicare Supplement Dental Option |
50% |
| Or |
Major Restorative Services
(teeth must have good prognosis)
| Benefit |
With Purchased Medicare Supplement Dental Option |
|
|---|---|---|
| Crowns and onlays (initial placement) |
With Purchased Medicare Supplement Dental Option |
50% coinsurance |
| Or | ||
| Recement of crowns and onlays |
With Purchased Medicare Supplement Dental Option |
50% coinsurance |
| Or | ||
| Inlays |
With Purchased Medicare Supplement Dental Option |
50% coinsurance |
| Or | ||
| Post and core or crown buildup |
With Purchased Medicare Supplement Dental Option |
50% coinsurance |
| Or |
Dental Glossary
-
Apicoectomy
The removal of inflamed gum tissue and the end of the tooth's root, while leaving the top of the tooth in place.
-
Bitewing X-rays
Provides details of the upper and lower teeth in one area of the mouth. Each bitewing shows a tooth from its crown (the exposed surface) to the level of the supporting bone. Many dentists include bitewing X-rays as part of routine diagnostic care.
Bone Grafting
Bone grafting is a surgical procedure that uses transplanted bone to replace missing or damaged bone in your mouth. If you’re getting a dental implant, you may also need a bone graft because it provides additional support. The bone graft is performed first, and you’ll need to wait 3 to 4 months for it to heal before getting the implant. Please note that implants are not covered with your dental plan.
-
Comprehensive Oral Exam
Performed by a dentist when evaluating a patient. Applies to new patients or established patients who have had change in health or have been absent from treatment for three or more years.
-
Front Teeth
Includes canines and all teeth in front of canines.
Full Mouth Debridement
The removal of plaque and tartar that interfere with the ability of the dentist to perform an oral examination. This is the most extensive cleaning procedure.
-
Guided Tissue Regeneration
Guided tissue regeneration is a procedure designed to remove infected soft tissue in your mouth, while stimulating the regrowth of healthy gum tissue.
-
Inlays
A dental inlay is a pre-molded restorative filling fitted into the grooves of your tooth. It restores cavities that are centered in your tooth instead of along the outer edges or "cusps."
-
Maximum Allowable Charge/Allowed Amount (MAC)
Amount that is negotiated with providers in the Dominion National dental network. This is the maximum allowed amount you can be charged for a service. For services with coinsurance, the amount you pay is calculated by multiplying the coinsurance rate with the MAC.
-
Onlays
An onlay is a treatment, like an inlay, which restores the cusp(s) of the tooth. The cusp (or cusps) of the tooth refer to the angled topmost surface of the tooth. Canine teeth have a single cusp, while bicuspids have two and molars may have four or five.
-
Periodic Oral Exam
Exam performed by a dentist as part of a routine checkup.
Periodontal Cleaning
Like a regular teeth cleaning, periodontal maintenance removes tartar buildup from the teeth. Unlike a normal, preventive cleaning, periodontal maintenance is a treatment prescribed to combat periodontal (gum) disease. It involves both scaling and root planning, meaning tartar must be removed from deep between the teeth and gums.
Posterior/Back Teeth
Includes any teeth behind the canines but does not include the canine teeth.
Protective Restorations
The placement of a restorative material to protect a tooth and/or surrounding tissue. This procedure may be used to relieve pain, promote healing, and prevent further deterioration.
-
Quadrants
Quadrants mean the four parts of your mouth. Your dentist sections the interior of your mouth into four parts for reference when providing treatment. The split is between the front teeth, split into upper right, upper left, lower right, lower left.
-
Rebase Denture
Rebasing may be recommended when the teeth of your denture are still in good condition and have not worn out in comparison to the denture base material. Rebasing is the process of replacing the entire acrylic denture base providing a stable denture without replacing the denture teeth.
Reline Denture
A denture reline is a simple procedure to reshape the underside of a denture so that it fits more comfortably on the user's gums. Relining is periodically necessary as dentures lose their grip in the mouth.
Retreatment Root Canal Therapy
Root canal retreatment is the removal of the previous crown and packing material left by a prior root canal, the cleansing of the canals, and the re-packing and re-crowning of the tooth.
Root Canal
A root canal is performed when the endodontist removes the infected pulp and nerve in the root of the tooth, cleans the inside of the root canal, then fills and seals the space. After completing a root canal your dentist will place a crown on the tooth to protect and restore it to its original function.
-
Scaling and Root Planning
Scaling and root planning is when your dentist removes all the plaque and tartar above and below the gumline, making sure to clean all the way down to the bottom of the tooth.
Scaling in Presence of Generalized Moderate/Severe Gingival Inflammation
The removal of plaque and stains from above and below the gumline when there is generalized gum inflammation. This procedure is for patients who have swollen, inflamed gums and bleeding on probing. This procedure is performed on the entire mouth rather than just one quadrant. It is also a higher degree of cleaning for patients with more advanced periodontal disease.
Single Tooth X-rays
Also sometimes referred to as a "periapical X-ray" a single tooth X-ray is one that captures the whole tooth. It shows everything from the crown (chewing surface) to the root (below the gum line).
-
Tissue Conditioning
Tissue conditioning is an effort to restore the health of the tissues of the denture foundation area prior to denture treatment.