2023 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 2023 Tufts Health Plan Medicare Supplement Dental Option to your plan, call 1-800-701-9000 (TTY: 711).

Dental Premium

$45.50/mo

For Medicare Supplement

Diagnostic Deductible

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

Comprehensive oral exam

Once every 36 months.

Medicare Supplement

Not covered

With Dental Option

Periodic oral evaluation

Two per year.

Medicare Supplement

Not covered

With Dental Option

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

Single tooth X-ray images

As needed.

Medicare Supplement

Not covered

With Dental Option

20%

Preventive Services

Routine cleaning, scaling, and polishing of teeth

Two per year.

Medicare Supplement

Not covered

With Dental Option

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

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

Surgical extractions

Once per tooth.

Medicare Supplement

Not covered

With Dental Option

50%

Periodontics

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

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

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)

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

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

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.