How Your Dental Benefit Works
Know What’s Covered and How to Use Your Benefit
Original Medicare does not typically cover routine dental care. Elderplan Select (HMO-POS I-SNP/IE-SNP) adds supplemental dental Coverage that helps pay for eligible dental services and includes a $1,950 dental allowance through your Flex Benefit at a $0 copayment, up to your annual allowance.
Your Dental Benefit at a Glance.
Your Dental Benefit at a Glance
Below is a quick summary of how to use your dental allowance. We recommend requesting a treatment estimate from your dentist before any non-routine dental care, so you know how much of your annual allowance will be used.
| $1,950 Annual Flex Spending Alternative | |
|---|---|
| Your annual allowance is loaded onto your OTC Card at the beginning of each plan year. Use your card to pay for eligible dental services, up to your annual allowance. Your benefit resets each year on January 1. Unused funds expire on December 31 and do not carry over. |
| Preventive & Diagnostic Care Supplemental Diagnostic & Preventive Dental | Comprehensive Care Supplemental Comprehensive Dental |
|---|---|
| Includes: Oral exams, cleanings (prophylaxis), dental x-rays, fluoride treatments, other diagnostic services, and other preventive dental services. Network: Any dentist network Frequency: Unlimited services up to your $1,950 annual allowance | Includes: Restorative services (fillings, crowns), endodontics (root canals), periodontics, prosthodontics (removable and fixed), implant services, oral and maxillofacial surgery, orthodontics, maxillofacial prosthetics and adjunctive general services. Network: Any dentist network Frequency: Unlimited services up to your $1,950 annual allowance |
Medicare-Covered Dental Services
In very limited situations, Medicare pays for dental services when they are an integral part of treatment for a primary medical condition. Examples include:
- Reconstruction of the jaw after a fracture or injury
- Tooth extractions are done in preparation for radiation treatment for cancer involving the jaw
- Oral exams before organ transplantation
- Inpatient hospital care for emergency or complicated dental procedures
These are different from your supplemental dental benefit and have a different cost share.
Important Reminders About Your Dental Benefits
$1,950 annual maximum applies.
Your covered supplemental dental services have a $0 copayment, but your benefit includes a combined annual maximum across preventive and comprehensive dental services. Once you reach the annual limit, you may be responsible for costs beyond it.
Unused allowance does not carry over.
Your allowance resets on January 1 each year. Any unused dollars at the end of the plan year expire and do not roll into the next year. Funds also expire immediately if you disenroll from the plan.
Ask for a treatment estimate.
Before non-routine dental work, ask your dentist to submit a coverage estimate to the plan so you know what will be covered and how much of your allowance will be used.