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2024 Tufts Medicare Preferred HMO Dental Coverage

Explore 2024 Tufts Medicare Preferred HMO Dental Coverage

Tufts Health Plan Medicare Preferred HMO Plan Members

The Tufts Health Plan Medicare Preferred Dental Coverage is administered by Dominion National, a leading administrator of dental benefits. The plan includes access to thousands of dentists across the region. Depending on your plan, you get coverage for preventive, restorative, and comprehensive services for no additional monthly premium; or coverage for preventive and restorative services for no additional monthly premium plus the option to upgrade to comprehensive coverage for a low additional monthly premium; or the option to add coverage for preventive, restorative, and comprehensive services for low additional monthly premium. 

 

The additional monthly premium is different depending on your plan selection. Tufts Medicare Preferred HMO Saver Rx, Tufts Medicare Preferred HMO Basic Rx and Tufts Medicare Preferred HMO Value Rx have embedded preventive and restorative dental benefits, therefore the premium for the additional dental coverage is lower. Tufts Medicare Preferred HMO Smart Saver Rx has embedded comprehensive coverage, therefore there is no additional monthly premium.

HMO Dental Benefit Essentials

Benefit

Smart Saver Rx Embedded

Saver, Basic, & Value Embedded

Saver, Basic, & Value Optional Buy-Up

Prime Rx+ & Prime Optional Dental Plan

Premium (Per Month)

Smart Saver Rx Embedded

N/A - Embedded

Saver, Basic, & Value Embedded

N/A - Embedded

Saver, Basic, & Value Optional Buy-Up

$21.50

Prime Rx+ & Prime Optional Dental Plan

$31.00

Or

Calendar Year Maximum

Smart Saver Rx Embedded

$2,500

Saver, Basic, & Value Embedded

$1,000

Saver, Basic, & Value Optional Buy-Up

$1,000

Prime Rx+ & Prime Optional Dental Plan

$1,000

Or

Individual Annual Deductible

Smart Saver Rx Embedded

$0

Saver, Basic, & Value Embedded

$0

Saver, Basic, & Value Optional Buy-Up

$0

Prime Rx+ & Prime Optional Dental Plan

$0

Or

Class I

Member Cost Share for Diagnostic & Preventative Services

Diagnostic & Preventative Services

Benefit

Smart Saver Rx Embedded

Saver, Basic, & Value Embedded

Saver, Basic, & Value Optional Buy-Up

Prime Rx+ & Prime Optional Dental Plan

Periodic oral evaluation
Two per year.

Smart Saver Rx Embedded

$0

Saver, Basic, & Value Embedded

$0

Saver, Basic, & Value Optional Buy-Up

$0

Prime Rx+ & Prime Optional Dental Plan

$0

Or

Comprehensive oral exam; Including the initial dental history and charting of teeth. 
Once every 36 months.

Smart Saver Rx Embedded

$0

Saver, Basic, & Value Embedded

$0

Saver, Basic, & Value Optional Buy-Up

$0

Prime Rx+ & Prime Optional Dental Plan

$0

Or

Intra oral bitewing X-ray images (X-rays of the crowns of the teeth) when oral conditions indicate need
Two per year.

Smart Saver Rx Embedded

$0

Saver, Basic, & Value Embedded

$0

Saver, Basic, & Value Optional Buy-Up

$0

Prime Rx+ & Prime Optional Dental Plan

$0

Or

Prophylaxis (routine cleaning, scaling, and polishing of teeth)
Two per year.

Smart Saver Rx Embedded

$0

Saver, Basic, & Value Embedded

$0

Saver, Basic, & Value Optional Buy-Up

$0

Prime Rx+ & Prime Optional Dental Plan

$0

Or

Class II

Member Cost Share for Basic Services

Basic Services

Benefit

Smart Saver Rx Embedded

Saver, Basic, & Value Embedded

Saver, Basic, & Value Optional Buy-Up

Prime Rx+ & Prime Optional Dental Plan

Emergency oral evaluation problem focused exams
Once every 12 months.

Smart Saver Rx Embedded

20%

Saver, Basic, & Value Embedded

50%

Saver, Basic, & Value Optional Buy-Up

20%

Prime Rx+ & Prime Optional Dental Plan

20%

Or

Intra oral X-ray image of the entire mouth (panoramic image)
Once every 60 months.

Smart Saver Rx Embedded

20%

Saver, Basic, & Value Embedded

50%

Saver, Basic, & Value Optional Buy-Up

20%

Prime Rx+ & Prime Optional Dental Plan

20%

Or

Intra oral X-ray image of the entire mouth (full mouth series)
Once every 60 months.

Smart Saver Rx Embedded

20%

Saver, Basic, & Value Embedded

50%

Saver, Basic, & Value Optional Buy-Up

20%

Prime Rx+ & Prime Optional Dental Plan

20%

Or

Single tooth X-ray images
As needed.

Smart Saver Rx Embedded

20%

Saver, Basic, & Value Embedded

50%

Saver, Basic, & Value Optional Buy-Up

20%

Prime Rx+ & Prime Optional Dental Plan

20%

Or

Silver fillings and white fillings
Once every 24 months per surface, per tooth.

Smart Saver Rx Embedded

20%

Saver, Basic, & Value Embedded

50%

Saver, Basic, & Value Optional Buy-Up

20%

Prime Rx+ & Prime Optional Dental Plan

20%

Or

Periodontal cleaning
Once every 6 months following active periodontal therapy, not to be combined with regular cleanings.

Smart Saver Rx Embedded

Covered in Class 3

Saver, Basic, & Value Embedded

50%

Saver, Basic, & Value Optional Buy-Up

20%

Prime Rx+ & Prime Optional Dental Plan

20%

Or

Scaling and root planning
Once in 24 months, per quadrant.

Smart Saver Rx Embedded

Covered in Class 3

Saver, Basic, & Value Embedded

50%

Saver, Basic, & Value Optional Buy-Up

20%

Prime Rx+ & Prime Optional Dental Plan

20%

Or

Scaling in presence of generalized moderate/severe gingival inflammation
Once per 24 months after oral evaluation and in lieu of a covered prophylaxis.

Smart Saver Rx Embedded

Covered in Class 3

Saver, Basic, & Value Embedded

50%

Saver, Basic, & Value Optional Buy-Up

20%

Prime Rx+ & Prime Optional Dental Plan

20%

Or

Full mouth debridement
Once per lifetime.

Smart Saver Rx Embedded

Covered in Class 3

Saver, Basic, & Value Embedded

50%

Saver, Basic, & Value Optional Buy-Up

20%

Prime Rx+ & Prime Optional Dental Plan

20%

Or

Simple extractions
Once per tooth.

Smart Saver Rx Embedded

Covered in Class 3

Saver, Basic, & Value Embedded

50%

Saver, Basic, & Value Optional Buy-Up

20%

Prime Rx+ & Prime Optional Dental Plan

20%

Or

Minor treatment for pain relief
Only if no services other than exam and X-rays were performed on the same date of service.

Smart Saver Rx Embedded

20%

Saver, Basic, & Value Embedded

50%

Saver, Basic, & Value Optional Buy-Up

20%

Prime Rx+ & Prime Optional Dental Plan

20%

Or

Class III

Member Cost Share for Major Restorative Services

Protective Restorations & Oral Surgery

Benefit

Smart Saver Rx Embedded

Saver, Basic, & Value Embedded

Saver, Basic, & Value Optional Buy-Up

Prime Rx+ & Prime Optional Dental Plan

Protective Restorations
Once per tooth.

Smart Saver Rx Embedded

50%

Saver, Basic, & Value Embedded

100%

Saver, Basic, & Value Optional Buy-Up

50%

Prime Rx+ & Prime Optional Dental Plan

50%

Or

Simple extractions
Once per tooth.

Smart Saver Rx Embedded

50%

Saver, Basic, & Value Embedded

Covered in Class II

Saver, Basic, & Value Optional Buy-Up

Covered in Class II

Prime Rx+ & Prime Optional Dental Plan

Covered in Class II

Or

Surgical extractions
Once per tooth.

Smart Saver Rx Embedded

50%

Saver, Basic, & Value Embedded

100%

Saver, Basic, & Value Optional Buy-Up

50%

Prime Rx+ & Prime Optional Dental Plan

50%

Or

Periodontics

Benefit

Smart Saver Rx Embedded

Saver, Basic, & Value Embedded

Saver, Basic, & Value Optional Buy-Up

Prime Rx+ & Prime Optional Dental Plan

Periodontal surgery
One surgical procedure per lifetime; gingivectomy or gingivoplasty and osseous surgery covered as needed.

Smart Saver Rx Embedded

50%

Saver, Basic, & Value Embedded

100%

Saver, Basic, & Value Optional Buy-Up

50%

Prime Rx+ & Prime Optional Dental Plan

50%

Or

Bone grafts and guided tissue regeneration
Once per lifetime.

Smart Saver Rx Embedded

50%

Saver, Basic, & Value Embedded

100%

Saver, Basic, & Value Optional Buy-Up

50%

Prime Rx+ & Prime Optional Dental Plan

50%

Or

Periodontal cleaning
Once every 6 months following active periodontal therapy, not to be combined with regular cleanings.

Smart Saver Rx Embedded

50%

Saver, Basic, & Value Embedded

Covered in Class II

Saver, Basic, & Value Optional Buy-Up

Covered in Class II

Prime Rx+ & Prime Optional Dental Plan

Covered in Class II

Or

Scaling and root planing
Once in 24 months, per quadrant.

Smart Saver Rx Embedded

50%

Saver, Basic, & Value Embedded

Covered in Class II

Saver, Basic, & Value Optional Buy-Up

Covered in Class II

Prime Rx+ & Prime Optional Dental Plan

Covered in Class II

Or

Scaling in presence of generalized moderate/severe gingival inflammation
Once per 24 months after oral evaluation and in lieu of a covered prophylaxis.

Smart Saver Rx Embedded

50%

Saver, Basic, & Value Embedded

Covered in Class II

Saver, Basic, & Value Optional Buy-Up

Covered in Class II

Prime Rx+ & Prime Optional Dental Plan

Covered in Class II

Or

Full mouth debridement
Once per lifetime.

Smart Saver Rx Embedded

50%

Saver, Basic, & Value Embedded

Covered in Class II

Saver, Basic, & Value Optional Buy-Up

Covered in Class II

Prime Rx+ & Prime Optional Dental Plan

Covered in Class II

Or

Endodontics

Benefit

Smart Saver Rx Embedded

Saver, Basic, & Value Embedded

Saver, Basic, & Value Optional Buy-Up

Prime Rx+ & Prime Optional Dental Plan

Root canal treatment
Once per tooth, per lifetime.

Smart Saver Rx Embedded

50%

Saver, Basic, & Value Embedded

100%

Saver, Basic, & Value Optional Buy-Up

50%

Prime Rx+ & Prime Optional Dental Plan

50%

Or

Retreatment root canal therapy
Once per tooth, per lifetime after 24 months of initial root canal therapy.

Smart Saver Rx Embedded

50%

Saver, Basic, & Value Embedded

100%

Saver, Basic, & Value Optional Buy-Up

50%

Prime Rx+ & Prime Optional Dental Plan

50%

Or

Apicoectomy
Covered as needed.

Smart Saver Rx Embedded

50%

Saver, Basic, & Value Embedded

100%

Saver, Basic, & Value Optional Buy-Up

50%

Prime Rx+ & Prime Optional Dental Plan

50%

Or

Prosthetic Maintenance

Benefit

Smart Saver Rx Embedded

Saver, Basic, & Value Embedded

Saver, Basic, & Value Optional Buy-Up

Prime Rx+ & Prime Optional Dental Plan

Bridge or denture repair
Once every 24 months per bridge or denture.

Smart Saver Rx Embedded

50%

Saver, Basic, & Value Embedded

100%

Saver, Basic, & Value Optional Buy-Up

50%

Prime Rx+ & Prime Optional Dental Plan

50%

Or

Tissue conditioning
One treatment per denture every 84 months.

Smart Saver Rx Embedded

50%

Saver, Basic, & Value Embedded

100%

Saver, Basic, & Value Optional Buy-Up

50%

Prime Rx+ & Prime Optional Dental Plan

50%

Or

Adding teeth to existing partial or full dentures
Once per tooth, per denture, per 24 months.

Smart Saver Rx Embedded

50%

Saver, Basic, & Value Embedded

100%

Saver, Basic, & Value Optional Buy-Up

50%

Prime Rx+ & Prime Optional Dental Plan

50%

Or

Rebase or reline of dentures
Once per denture every 24 months.

Smart Saver Rx Embedded

50%

Saver, Basic, & Value Embedded

100%

Saver, Basic, & Value Optional Buy-Up

50%

Prime Rx+ & Prime Optional Dental Plan

50%

Or

Adjunctive Services

Provided in conjunction with the primary treatment.

Benefit

Smart Saver Rx Embedded

Saver, Basic, & Value Embedded

Saver, Basic, & Value Optional Buy-Up

Prime Rx+ & Prime Optional Dental Plan

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.

Smart Saver Rx Embedded

50%

Saver, Basic, & Value Embedded

100%

Saver, Basic, & Value Optional Buy-Up

50%

Prime Rx+ & Prime Optional Dental Plan

50%

Or

Prosthodontics

Benefit

Smart Saver Rx Embedded

Saver, Basic, & Value Embedded

Saver, Basic, & Value Optional Buy-Up

Prime Rx+ & Prime Optional Dental Plan

Dentures (complete or partial dentures)
One per arch within 84 months.

Smart Saver Rx Embedded

50%

Saver, Basic, & Value Embedded

100%

Saver, Basic, & Value Optional Buy-Up

50%

Prime Rx+ & Prime Optional Dental Plan

50%

Or

Fixed bridges
Once per 84 months. Note: 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.

Smart Saver Rx Embedded

50%

Saver, Basic, & Value Embedded

100%

Saver, Basic, & Value Optional Buy-Up

50%

Prime Rx+ & Prime Optional Dental Plan

50%

Or

Temporary partial dentures
Once per 84 months. Note: 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.

Smart Saver Rx Embedded

50%

Saver, Basic, & Value Embedded

100%

Saver, Basic, & Value Optional Buy-Up

50%

Prime Rx+ & Prime Optional Dental Plan

50%

Or

Major Restorative Services

(teeth must have good prognosis)

Benefit

Smart Saver Rx Embedded

Saver, Basic, & Value Embedded

Saver, Basic, & Value Optional Buy-Up

Prime Rx+ & Prime Optional Dental Plan

Crowns and onlays (initial placement)
When teeth cannot be restored with regular fillings due to fracture or decay, once within 84 months per tooth. Note: If a member chooses a porcelain/ceramic crown, porcelain fused to high noble metal crown, or a titanium/titanium alloy crown, the maximum allowed by the Plan will be for the less expensive alternate treatment which is the porcelain fused to predominately base metal crown and the member will be responsible for the difference between the two crown procedures. Implant supported crowns are not covered services.

Smart Saver Rx Embedded

50%

Saver, Basic, & Value Embedded

100%

Saver, Basic, & Value Optional Buy-Up

50%

Prime Rx+ & Prime Optional Dental Plan

50%

Or

Recement of crowns and onlays
Once per tooth, per 12 months.

Smart Saver Rx Embedded

50%

Saver, Basic, & Value Embedded

100%

Saver, Basic, & Value Optional Buy-Up

50%

Prime Rx+ & Prime Optional Dental Plan

50%

Or

Inlays
Once per tooth, per 84 months.

Smart Saver Rx Embedded

50%

Saver, Basic, & Value Embedded

100%

Saver, Basic, & Value Optional Buy-Up

50%

Prime Rx+ & Prime Optional Dental Plan

50%

Or

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.

Smart Saver Rx Embedded

50%

Saver, Basic, & Value Embedded

100%

Saver, Basic, & Value Optional Buy-Up

50%

Prime Rx+ & Prime Optional Dental Plan

50%

Or

Dental FAQs

The dental network is provided by Dominion National. To utilize your dental coverage, you must use a dentist in the Dominion PPO Network. Dominion National provides you with access to hundreds of participating dentists. To view the list of participating dentists in the Dominion PPO Network, go to thpmp.org/dentist.

If you have embedded dental coverage or decide to add dental coverage to your plan, you will receive a Dominion National ID card by mail to use for your dental coverage. If you don’t receive your card within 3 weeks of joining the plan, call Member Services at 1-800-701-9000 (TTY: 711).

Services include a cleaning, periodic oral evaluation, and sometimes bitewing X-rays. A comprehensive oral exam only occurs for a new patient or to evaluate an issue.

We recommend asking your dentist to submit a pre-treatment estimate to Dominion National before your treatment begins. The dentist can submit the exact services or procedures they plan to provide in your treatment plan and Dominion National will respond with confirmation of whether the service will be covered and the estimated out-of-pocket cost you will be expected to pay. 

  • The pre-treatment estimate will be reviewed, and an estimate statement will be issued to you or the provider. The statement will include details of the services that will be covered by your plan along with your estimated responsibility and potential payment to the dental office. 
  • The pre-treatment estimate is based on eligibility and benefits available at the time it is processed. A pre-treatment estimate is not required to obtain care.
  • A pre-treatment estimate is not a guarantee of payment. The claim for services performed will be based on eligibility and available benefits at the time it is submitted for payment. Other procedures performed, especially in the same area/quadrant/tooth, could affect the actual claim determination/payment.

A simple dental extraction is the procedure of removing teeth that are visible and easily accessible. In contrast, surgical dental extraction often involves an incision to get access to the tooth to be removed.

Inlays and onlays use the same materials as crowns and they both serve the same function, but they cover different areas of the tooth when there is tooth decay. The difference between an onlay and an inlay is that an onlay will treat the cusp, whereas an inlay only restores the area between the cusps.

Fillings can be performed using either composite (tooth-colored/white) or amalgam (metal/silver) restorative materials. If a tooth-colored filling is submitted for a back tooth, the coverage provided will be for a comparable metal filling. You and your dentist may still choose a white filling, but you will be responsible for the difference in cost between the white and silver fillings. If you would like a better estimate of your payment, we urge you to ask your dentist to submit a pretreatment estimate.

Bone grafting and guided tissue regeneration are two separate but related procedures that your dentist can use to save natural teeth from failing due to the loss of healthy tissue from gum disease. By regenerating the lost bone and tissues surrounding a tooth, these restored structures will create the protective, strong foundation a tooth needs to remain healthy long term.

Crowns can be manufactured from a variety of materials, such as high noble metals, base metals, porcelain fused to metal (PFM) and ceramic compounds. Your dental plan covers crowns manufactured with porcelain fused to predominantly base metal. You and your dentist may still choose a crown made from more costly materials, but you will be responsible for the difference in cost between the predominantly base metal crown and the crown of your choosing. If you would like a better estimate of your payment, we urge you to ask your dentist to submit a pre-treatment estimate.

Dental Glossary

  • Apicoectomy

    The removal of inflamed gum tissue and the end of the tooth's root, while leaving the top of the tooth in place.

  • Bitewing X-rays

    Provides details of the upper and lower teeth in one area of the mouth. Each bitewing shows a tooth from its crown (the exposed surface) to the level of the supporting bone. Many dentists include bitewing X-rays as part of routine diagnostic care.

    Bone Grafting

    Bone grafting is a surgical procedure that uses transplanted bone to replace missing or damaged bone in your mouth. If you’re getting a dental implant, you may also need a bone graft because it provides additional support. The bone graft is performed first, and you’ll need to wait 3 to 4 months for it to heal before getting the implant. Please note that implants are not covered with your dental plan.

  • Comprehensive Oral Exam

    Performed by a dentist when evaluating a patient. Applies to new patients or established patients who have had change in health or have been absent from treatment for three or more years.

  • Front Teeth

    Includes canines and all teeth in front of canines.

    Full Mouth Debridement

    The removal of plaque and tartar that interfere with the ability of the dentist to perform an oral examination. This is the most extensive cleaning procedure.

  • Guided Tissue Regeneration

    Guided tissue regeneration is a procedure designed to remove infected soft tissue in your mouth, while stimulating the regrowth of healthy gum tissue.

  • Inlays

    A dental inlay is a pre-molded restorative filling fitted into the grooves of your tooth. It restores cavities that are centered in your tooth instead of along the outer edges or "cusps."

  • Maximum Allowable Charge/Allowed Amount (MAC)

    Amount that is negotiated with providers in the Dominion National dental network. This is the maximum allowed amount you can be charged for a service. For services with coinsurance, the amount you pay is calculated by multiplying the coinsurance rate with the MAC.

  • Onlays

    An onlay is a treatment, like an inlay, which restores the cusp(s) of the tooth. The cusp (or cusps) of the tooth refer to the angled topmost surface of the tooth. Canine teeth have a single cusp, while bicuspids have two and molars may have four or five.

  • Periodic Oral Exam

    Exam performed by a dentist as part of a routine checkup.

    Periodontal Cleaning

    Like a regular teeth cleaning, periodontal maintenance removes tartar buildup from the teeth. Unlike a normal, preventive cleaning, periodontal maintenance is a treatment prescribed to combat periodontal (gum) disease. It involves both scaling and root planning, meaning tartar must be removed from deep between the teeth and gums.

    Posterior/Back Teeth

    Includes any teeth behind the canines but does not include the canine teeth.

    Protective Restorations

    The placement of a restorative material to protect a tooth and/or surrounding tissue. This procedure may be used to relieve pain, promote healing, and prevent further deterioration.

  • Quadrants

    Quadrants mean the four parts of your mouth. Your dentist sections the interior of your mouth into four parts for reference when providing treatment. The split is between the front teeth, split into upper right, upper left, lower right, lower left.

  • Rebase Denture

    Rebasing may be recommended when the teeth of your denture are still in good condition and have not worn out in comparison to the denture base material. Rebasing is the process of replacing the entire acrylic denture base providing a stable denture without replacing the denture teeth.

    Reline Denture

    A denture reline is a simple procedure to reshape the underside of a denture so that it fits more comfortably on the user's gums. Relining is periodically necessary as dentures lose their grip in the mouth.

    Retreatment Root Canal Therapy

    Root canal retreatment is the removal of the previous crown and packing material left by a prior root canal, the cleansing of the canals, and the re-packing and re-crowning of the tooth.

    Root Canal

    A root canal is performed when the endodontist removes the infected pulp and nerve in the root of the tooth, cleans the inside of the root canal, then fills and seals the space. After completing a root canal your dentist will place a crown on the tooth to protect and restore it to its original function.

  • Scaling and Root Planning

    Scaling and root planning is when your dentist removes all the plaque and tartar above and below the gumline, making sure to clean all the way down to the bottom of the tooth.

    Scaling in Presence of Generalized Moderate/Severe Gingival Inflammation

    The removal of plaque and stains from above and below the gumline when there is generalized gum inflammation. This procedure is for patients who have swollen, inflamed gums and bleeding on probing. This procedure is performed on the entire mouth rather than just one quadrant. It is also a higher degree of cleaning for patients with more advanced periodontal disease.

    Single Tooth X-rays

    Also sometimes referred to as a "periapical X-ray" a single tooth X-ray is one that captures the whole tooth. It shows everything from the crown (chewing surface) to the root (below the gum line).

  • Tissue Conditioning

    Tissue conditioning is an effort to restore the health of the tissues of the denture foundation area prior to denture treatment.