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Home > All 2018 Plans > 2018 Tufts Medicare Preferred HMO - Delta Dental® Option

2018 Tufts Medicare Preferred HMO - Delta Dental® Option

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Premium
$
54.00
Per Month
$0
Diagnostic Deductible
$0
Preventive Deductible
$50
Deductible for all other services
$1,000
Maximum benefit per year

Members of Tufts Health Plan Medicare Preferred HMO plans are now eligible to enroll in a new dental coverage option from Delta Dental® of Massachusetts for just $54 a month. The Delta Dental® Option provides excellent dental coverage that:

  • Provides comprehensive benefits with no out-of-pocket costs for covered preventive services such as teeth cleanings and fluoride treatments.
  • Pays 50-80% for restorative services such as tooth extractions, dentures, crowns, and more! Waiting periods apply. 
  • Features an affordable annual deductible of $50 per calendar year. 
  • Access to the limited Delta Dental PPOSM network of dentists across the nation, with many dentists in Massachusetts. Click HERE to see if your dentist is in the Delta Dental PPO network.

You can add dental to any Tufts Medicare Preferred HMO plan for $54 per month.

How it works

  • Confirm your dentist is in the Tufts Medicare Preferred dental network, or find a new dentist in the network. Click HERE to search the Delta Dental PPO network.
  • The cost for the Tufts Health Plan Delta Dental® Option is just $54 a month. This cost is in addition to your Tufts Medicare Preferred HMO plan’s monthly premium. 
  • There is a $50 annual deductible. After it is met Delta Dental® pays some or all of the cost for your dental care, up to your $1,000 benefit maximum per year. (The benefit summary below details how different services are covered.)
  • Once the $1,000 is used up, you are responsible for the cost of other care you receive, but you can continue to get the Delta Dental® discounted rates on dental costs.
  • If you had dental coverage with Delta Dental® of Massachusetts in the last 60 days, all waiting periods will be waived to allow you to receive coverage right away.

Please note that the Delta Dental Option utilizes the Delta Dental PPO network, which is a limited network. This network of dentists may be different than in Delta Dental coverage you had previously through other sources, such as an employer. Prior to scheduling an appointment with your dentist, please confirm that your dentist participates in the network to prevent services from being denied.

How to enroll

The Delta Dental® Option is available in addition to your Tufts Health Plan Medicare Preferred medical coverage. New members can add it to their plans during enrollment or up to 30 days after your coverage has started. Current members whose coverage has rolled over for 2017 have until January 31, 2017 to enroll in the Delta Dental® Option. It is not automatically included.

Current Tufts Health Plan Medicare Preferred HMO Members Enroll Here

In order to be eligible your Tufts Health Plan Medicare Preferred HMO plan coverage must have started within the last 30 days.

Enroll by Phone: To sign up for the Delta Dental Option call Customer Relations at 1-800-701-9000 (TTY 1-800-208-9562).

Tufts Health Plan Medicare Preferred Delta Dental® Option Coverage Summary

Fully Covered Services

Diagnostic
Benefit Limit
Comprehensive Evaluation Once every 60 months
Periodic Oral Exam Once every 6 months
Bitewing X-rays Once every 6 months
Single Tooth X-rays As needed
Member Pays
Covered in Full Covered in Full Covered in Full Covered in Full
Preventive
Benefit Limit
Teeth Cleaning Once every 6 months
Fluoride Treatments Once every 6 months
Chlorhexidine Mouthrinse Following scaling and root planing
Fluoride Toothpaste Following periodontal surgery
Member Pays
Covered in full Covered in full Covered in full Covered in full

Partially Covered Services

There is a six month waiting period that applies to these services, except for Emergency Dental Care. If you had dental coverage with Delta Dental® of Massachusetts in the last 60 days all waiting periods are waived.

Restorative
Benefit Limit
Silver Fillings Once every 24 months per surface per tooth
White Fillings (Front Teeth) Once every 24 months per surface per tooth
White Fillings (Back Teeth) Covered only for single services Covered only for single surfaces. Once every 24 months per surface, per tooth, multi-surfaces will be processed as a silver filling and the patient is responsible up to the submitted charge.
Temporary Fillings Once per tooth
Stainless Steel Crowns Once every 24 months per tooth
Member Pays
20% After Deductible 20% After Deductible 20% After Deductible 20% After Deductible 20% After Deductible
Oral Surgery
Benefit Limit
Simple Extractions Once per tooth
Surgical Extractions Once per tooth
Member Pays
20% After Deductible 20% After Deductible
Periodontics
Benefit Limit
Periodontal Surgery Once procedure per quadrant in 36 months
Scaling and Root Planning Once in 24 months, per quadrant
Member Pays
20% After Deductible 20% After Deductible
Periodontal Cleaning Once every 3 months Following active periodontal treatment. Not to be combined with preventive cleanings.
Member Pays
Covered in Full
Endodontics
Benefit Limit
Root Canal Treatment Once per tooth
Member Pays
20% After Deductible
Prosthetic Maintenance
Benefit Limit
Bridge or Denture Repair Once within 12 months, same repair
Rebase or Reline of Dentures Once within 36 months
Recement of Crowns & Onlays Once per tooth
Member Pays
20% After Deductible 20% After Deductible 20% After Deductible
Adjunctive Services
Benefit Limit
Minor Pain Relief Treatment 3 occurrences in 12 months *Services provided in conjunction with the primary treatment.
General Anesthesia General anesthesia and IV sedations are allowed with covered surgical impacted wisdom teeth only *Services provided in conjunction with the primary treatment.
Member Pays
20% After Deductible 20% After Deductible
Prosthodontics
Benefit Limit
Dentures Once within 60 months
Fixed Bridges and Crowns Once within 60 months, when part of a bridge
Implants (only in lieu of a 3-unit bridge) Once within 60 months per implant An Endosteal Implant: Only when it is to replace one missing tooth and when adjacent teeth are healthy and do not require crowns. (Pre-estimates recommended.)
Member Pays
50% After Deductible 50% After Deductible 50% After Deductible
Major Restorative
Benefit Limit
Crowns Once within 60 months per tooth When teeth cannot be restored with regular fillings
Member Pays
50% After Deductible

Note: No prior authorization required under this plan.

*Plan pays up to calendar year maximum

The chart above is a summary. For complete coverage details, call Customer Relations or see your Evidence of Coverage (EOC) booklet.

Note: May not be available to members who are enrolled in a Group plan through their current or former employer. Tufts Health Plan is an HMO plan with a Medicare contract. Enrollment in Tufts Health Plan depends on contract renewal.

Delta Dental of Massachusetts is an Independent Licensee of the Delta Dental Plans Association. ®Registered

Marks of the Delta Dental Plans Association. This plan is administered by Delta Dental® of Massachusetts.

Please see Evidence of Coverage with Tufts Health Plan for complete details of your rights and obligations. Should any discrepancy arise, any such Evidence of Coverage supersedes this benefit information.