2021 Dental Plans | 2021 Medicare Options

Dental care is essential to your overall health! With our plans, you have the freedom to access a network that offers more than 90 percent of practicing local dentists and more than 350,000 provider locations nationwide.

3 Plans to Choose From

Dental Blue 65 Preventive

$22.70

Per Month

Key Features

Pays 100% of preventive covered services
No calendar year maximum or deductible
Enhanced Dental Benefits for at-risk members with qualifying medical conditions

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Dental Blue 65 Basic

$37.80

Per Month

Key Features

Pays 100% of preventive services and 50% of basic services
$100 annual deductible and $1,250 calendar-year maximum
Enhanced Dental Benefits for at-risk members with qualifying medical conditions

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Dental Blue 65 Premier

$68.70

Per Month

Key Features

Pays 100% of preventive services, 80% of basic services, and 50% of premier services
$50 annual deductible and $1,500 calendar-year maximum
Enhanced Dental Benefits for at-risk members with qualifying medical conditions

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Covered Services

	Preventive $22.70 per month	Basic $37.80 per month	Premier $68.70 per month
Diagnostic Services—no waiting period				More Details One complete initial oral exam, including initial dental history, and charting your teeth and supporting structures (gums, bones) to evaluate their condition Full mouth X-rays (seven or more films), or panoramic X-ray with bitewing X-rays, once every 60 months Additional bitewing X-rays once every six months Periodic or routine oral exams 3 times per 12 months. Emergency exams Single tooth X-rays as needed Study models and casts used in planning treatment once every 60 months.
Preventive Services—no waiting period				More Details Routine cleaning, scaling, and polishing of the teeth 3 times per 12 months No waiting period for routine preventive services
Basic Services—available after six month waiting period.*				More Details Silver and white fillings for each tooth surface in each 12 months Tooth extractions and biopsies Periodontal scaling and root planning, once in each quadrant each 24 months Periodontal surgery, once in each quadrant each 36 months Periodontal maintenance, once each three months Root Canals Repairs of partial or complete dentures, crowns and bridges, once each 12 months Rebase or reline of dentures, once each 36 months Recementing of crowns, inlays, onlays and fixed bridgework, once each 12 months Bite adjustment, once each 24 months Services to treat root sensitivity General anesthesia when administered in conjunction with covered surgical services Emergency dental treatment to relieve acute pain
Major Services—available after 12 month waiting period.* These services are in addition to all Preventive and Basic services listed				More Details Complete or partial denture, including services to fabricate, measure, fit and adjust, once each 60 months for each arch Fixed bridges, including services to fabricate, measure, fit and adjust, once each 60 months per tooth Replacement of dentures and bridges, but only when they are installed at least 60 months after the initial placement, and only if the existing appliance cannot be made serviceable Adding teeth to an existing bridge Temporary partial dentures to replace any of the six upper or lower front teeth, but only if they are installed immediately following the loss of teeth and during the period of healing Metallic, porcelain, and white resin inlays, once every 60 months per tooth Replacement of crowns and metallic, porcelain and composite resin inlays/onlays once every 60 months for each tooth Post and core or crown build up once every 60 months per tooth Surgical placement of dental implant once per tooth per lifetime

*You may be eligible to have all waiting periods waived to allow you to receive minor and major restorative services right away.

Learn More

For Dental Blue 65 Preventive, Basic, and Premier detailed plan information, please refer to the Outline of Coverage:

Dental Blue 65 Outline of Coverage

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Visit the Enroll section for information on how to enroll via phone, mail, fax, or online.