2022 Tufts Health Plan Medicare Supplement Dental Option

Tufts Health Plan makes it easy to get comprehensive dental coverage for the services you need now—and the ones you may need later!
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About the Plan

The Tufts Health Plan Medicare Supplement Dental 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. 

If you are an existing member and would like to add the 2021 Tufts Health Plan Medicare Supplement Dental Option to your plan, call 1-800-701-9000 (TTY: 711).

Dental Premium
$48.00/mo
For Medicare Supplement
$0
Diagnostic Deductible
$0
Deductible
$1,000
Calendar Year Maximum

What's covered?

The charts displayed below represent what the member pays for dental services such as diagnostic, preventive, restorative, oral surgery, prosthodontics, and more. The amount you pay for a particular service may vary depending on the dentist you choose.

Diagnostic Services

Benefit
Medicare Supplement
With Dental Option
Comprehensive oral exam
Once every 36 months.
Medicare Supplement
Not covered
With Dental Option
$0
Periodic oral evaluation
Two per year.
Medicare Supplement
Not covered
With Dental Option
$0
Emergency oral evaluation problem focused exams
Once every 12 months.
Medicare Supplement
Not covered
With Dental Option
20%
Intra-oral X-ray image of the entire mouth
Panoramic image. Once every 60 months.
Medicare Supplement
Not covered
With Dental Option
20%
Intra-oral X-ray image of the entire mouth
Full mouth series. Once every 60 months.
Medicare Supplement
Not covered
With Dental Option
20%
Intra-oral bitewing X-ray images
X-rays of the crowns of the teeth. Completed when oral conditions indicate need. Two per year.
Medicare Supplement
Not covered
With Dental Option
$0
Single tooth X-ray images
As needed.
Medicare Supplement
Not covered
With Dental Option
20%

Preventive Services

Benefit
Medicare Supplement
With Dental Option
Routine cleaning, scaling, and polishing of teeth
Two per year.
Medicare Supplement
Not covered
With Dental Option
$0
Periodontal cleaning
Once every 6 months following active periodontal therapy, not to be combined with regular cleanings.
Medicare Supplement
Not covered
With Dental Option
20%

Restorative Services

Benefit
Medicare Supplement
With Dental Option
Silver fillings and white fillings (front teeth)
Once every 24 months per surface per tooth. White filings on posterior teeth will be processed as a silver filling and the patient is responsible up to the contracted fee.
Medicare Supplement
Not covered
With Dental Option
20%
White fillings (back teeth)
Once every 24 months per surface, per tooth.
Medicare Supplement
Not covered
With Dental Option
20%
Protective restorations
Once per tooth.
Medicare Supplement
Not covered
With Dental Option
50%
Simple extractions
Once per tooth.
Medicare Supplement
Not covered
With Dental Option
20%
scalling and root planing
Once in 24 months, per quadrant.
Medicare Supplement
Not covered.
With Dental Option
20%

Oral Surgery

Benefit
Medicare Supplement
With Dental Option
Surgical extractions
Once per tooth.
Medicare Supplement
Not covered
With Dental Option
50%

Periodontics

Benefit
Medicare Supplement
With Dental Option
Periodontal surgery
One surgical procedure per lifetime; gingivectomy or gingivoplasty and osseous surgery covered as needed.
Medicare Supplement
Not covered
With Dental Option
50%
Bone grafts and guided tissue regeneration
Once per lifetime.
Medicare Supplement
Not covered
With Dental Option
50%

Endodontics

Benefit
Medicare Supplement
With Dental Option
Root canal treatment
Once per tooth per lifetime.
Medicare Supplement
Not covered
With Dental Option
50%
Retreatment root canal therapy
Once per tooth per lifetime at least 24 months after initial root canal therapy.
Medicare Supplement
Not covered
With Dental Option
50%
Apicoectomy
As needed.
Medicare Supplement
Not covered
With Dental Option
50%

Prosthetic Maintenance

Benefit
Medicare Supplement
With Dental Option
Bridge or denture repair
Once every 24 months per bridge or denture.
Medicare Supplement
Not covered
With Dental Option
50%
Tissue conditioning
One treatment per denture every 84 months.
Medicare Supplement
Not covered
With Dental Option
50%
Adding teeth to existing partial or full dentures
Once per tooth, per denture, per 24 months.
Medicare Supplement
Not covered
With Dental Option
50%
Rebase or reline of dentures
Once per denture every 24 months.
Medicare Supplement
Not covered
With Dental Option
50%

Adjunctive Services (provided in conjunction with the primary treatment)

Benefit
Medicare Supplement
With Dental Option
Minor treatment for pain relief
Only if no services other than exam and X-rays were performed on the same date of service.
Medicare Supplement
Not covered
With Dental Option
20%
Local Anesthesia and inhalation of nitrous oxide/analgesia, anxiolysis
Local Anesthesia and inhalation of nitrous oxide/analgesia, anxiolysis are provided in conjunction with covered oral surgery or periodontal surgery and are integral to the primary treatment.
Medicare Supplement
Not covered
With Dental Option
50%

Prosthodontics

Benefit
Medicare Supplement
With Dental Option
Dentures
Complete or partial dentures; one per arch within 84 months.
Medicare Supplement
Not covered
With Dental Option
50%
Fixed bridges
Once per 84 months; a posterior fixed bridge and a removable denture are not covered in the same arch within 84 months; if a denture in the same arch as the fixed bridge was covered within 84 months, there will be no benefit for the fixed bridge.
Medicare Supplement
Not covered
With Dental Option
50%
Temporary partial dentures
Once per 84 months; to replace any of the six upper or lower front teeth, but only if the temporary partial dentures are installed immediately following the loss of teeth during the period of healing.
Medicare Supplement
Not covered
With Dental Option
50%

Major Restorative

Benefit
Medicare Supplement
With Dental Option
Crowns and onlays-initial placement
When teeth cannot be restored with regular filings due to fracture or decay. Once within 84 months per tooth.
Medicare Supplement
Not covered
With Dental Option
50%
Post and core or crown buildup
When needed to retain a crown on a tooth with excessive breakdown due to caries and/or fractures. Once per tooth every 84 months.
Medicare Supplement
Not covered
With Dental Option
50%
Inlays
Once per tooth per 84 months.
Medicare Supplement
Not covered
With Dental Option
50%
Recement of crowns and onlays
Once per tooth per 12 months.
Medicare Supplement
Not covered
With Dental Option
50%

Interested in adding the Tufts Health Plan Medicare Supplement Dental Option to your plan?

It's easy to add the Tufts Health Plan Medicare Supplement Dental Option to your plan. Just call 1-800-701-9000 (TTY: 711) and one of our Medicare Experts can answer any questions you have and enroll you in just a few minutes.

The Tufts Health Plan Medicare Supplement Dental Option is in addition to your medical coverage with Tufts Health Plan Medicare Supplement plans. It is not automatically included. To add the Dental Option to your plan, call 1-800-701-9000. The plan is administered by Dominion Dental Services, Inc., which operates under the trade name Dominion National.