Dental care is an important part of taking care of your overall health.
Many of our Medicare Advantage plans include dental benefits and we know that you may have questions about your dental coverage. We're here to answer your questions and break it down for you. Let's get started!
What's Included in My Dental Benefits?
Depending on your plan, your dental benefits may include oral exams, cleanings, fluoride treatments, x-rays and emergency services. Some plans also cover dentures.
Where Can I Find Information About My Dental Benefits?
You can find more information about your benefits, including what exact services are covered by your plan, by checking your dental benefits details located in the member portal with your plan documents.
How Do I Find an In-Network Dentist?
It's important to make sure your dentist is in-network. If you see a dentist that's not in your plan's network, your exam and other services may not be covered by your plan, which means you may have to pay more out-of-pocket. To find an in-network dentist near you, go to your secure member portal and use the Find a Provider tool.
When Should I See a Dentist or a Specialist?
You should see your dentist for an oral exam and cleaning twice a year. You should also schedule an appointment with your dentist whenever you have problems with your teeth, jaw or gums.
What Procedures May Need a Referral From My Dentist?
Your dentist may refer you to a specialist, like an oral surgeon, an endodontist or a periodontist if you need a special procedure like a root canal or tooth extraction.
What Happens at a Dental Exam?
A dental exam helps your dentist assess the overall health of your mouth, teeth and jaw. Every dental exam may be slightly different based on the situation. However, most dental exams include dental X-rays, an oral exam, a check for signs of oral cancer and a teeth cleaning.
How Do I Pay for My Dental Services?
Your member ID card is the key to receiving the care you need. You will need to bring your Member ID card with you to all your appointments. If you have a dual plan that includes both Medicaid and Medicare, you will need to bring BOTH cards to your appointments.
If you can't find your Member ID card, you can log into your member portal and print a copy or log in on your cell phone to view your digital ID card. Depending on your plan, you may also get a separate dental card you have to bring with you too.
When you go to pay, make sure to mention the name of your dental vendor, which is listed on the back of your Member ID Card.
Can I Get Reimbursed for My Out-Of-Pocket Expenses?
If you are a PPO plan member who pays out of pocket for your out-of-network provider, you may submit for reimbursement. Make sure to save your receipts. To apply for reimbursement, call the phone number for dental services listed on the back of your ID card. They can also review your account and answer your dental questions.
Note that this number is different than the number you would call to reach Member Services. You can call your dental vendor between 8am and 8pm Monday through Friday.
Additional Questions?
Call Member Services at the phone number on your Member ID Card. TTY users dial 711. From April 1 - September 30, we're here Monday through Friday from 8 am to 8 pm. From October 1 - March 31, we're here every day from 8 am to 8 pm.
