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Medicare 2022 Dental

Explore your Medicare coverage options

Take Care of Your Smile & Health

We’re happy to offer quality dental coverage. Having healthy teeth and gums can help prevent certain health risks caused by poor oral hygiene, like diabetes and heart disease. That’s why we contract with Healthplex to help manage the dental needs of our members. Healthplex has a large network of participating dentists and specialists.

Your plan may include preventive and/or comprehensive dental benefits. If it does not, you can buy optional supplemental dental benefits for an additional low monthly premium. There are two PPO plans or one indemnity plan to choose from. Each option is tailored to meet your needs. 

 

PPO plans give you the most cost saving by staying in-network. Services provided by a non-network dentist will be reimbursed according to the out-of-network allowance. After your deductible and/or cost-share amount, you will be responsible for the difference between the out-of-network allowance and the total amount billed by a non-network dentist.

 

Indemnity plan gives you the most flexibility when it comes to choosing your dentist with no Network. We will reimburse you 50% of the costs of any dental services you paid for, up to the plan annual maximum.

 

Enrolling in a ConnectiCare optional dental plan as a ConnectiCare member, you can:

 • Enroll and drop an optional dental plan at any time during the calendar year

 • Change to a different optional dental plan from 10/15/2021 through 12/31/2021*.

 • Upgrade your optional dental plan from 01/01/2022 through 03/31/2022.

 

*Note: If you later disenroll in your optional dental plan, you can only re-enroll in that dental plan. You cannot switch to a different dental plan.

Preventive Dental Services Include:

  • One every six months: oral exams, cleanings, fluoride, standard x-rays (bitewings)
  • One every 36 months: complete series x-rays (panorex) 

 

Comprehensive Dental Services Include:

  • Basic (minor restorative) – restorations (fillings)
  • Major (endodontics, periodontics, and oral surgery) includes crowns, dentures and more.
    • Prior authorization may be required for some services 

 

General 2022 Dental Information

With our PPO Dental plans, we do have a network, but you can go to any Medicare approved dental provider – which provider you use will determine your out of pocket costs. These two options have a deductible and costshares based on the services provided. There are some services that may require prior authorization.

 

You’ll save more when you receive care from one of our in-network dental providers. To see participating providers contact Member services, our Medicare Connect Concierge at 800-224-2273 (TTY: 711) or visit search our online directory.

 

If you see an out-of-network, non-participating Medicare approved dentist for covered dental services, you may pay more. In addition to your deductible and/or cost share amount, you will be responsible for the difference between the out-of-network allowance and the total amount billed by a non-participating dentist

 

In Network

Service: Sample Service

Provider Billed Amount $1295
Contracted Rate: $700
Benefit 50% $350
Deductible $100
Member Pays $450

*Examples only

 

Out-of-Network

Service: Sample Service

Provider Billed Amount $1295
Out-of-Network Allowance $300
Plan Pays 50% of Allowance $150
Deductible $100
Difference Billed/Allowed $995
Member 50% Costshare $150
Member Pays $1245

*Examples only

 

You should ask the dentist to bill ConnectiCare directly using the address on the back of your ID card. Be aware you may be asked to pay your bill directly to your dentist and then seek easy reimbursement from us. If you do pay the bill at the time the service is provided, be sure to get a paid receipt. Send a copy of the paid receipt, along with a completed dental reimbursement form, to the address on the back of your ID card. You can submit the dental reimbursement form, or call us and we will mail you the form.

Always keep a copy of all documents for your records. You must submit your claim to us within 12 months of the date you received the service.

 

Check your Cost Sharing guide for what is covered and how much you will have to pay. Or call Healthplex at 855-973-2803 (TTY: 711). 

With our Indemnity plan, there is no network, no prior authorizations and easy reimbursement! You do have to use Medicare approved dental providers for dental services.

 

This dental option includes preventive and comprehensive services. You will pay 50% of the billed charges for any dental service and our plan will pay 50% of the billed charges up to the plan maximum.

Service: Sample Service
Provider Billed Amount $1295
Plan Pays 50%  $647.50
Member Pays $647.50

 

You should ask the dentist to bill ConnectiCare directly using the address on the back of your ID card. Be aware you may be asked to pay your bill directly to your dentist and then seek reimbursement from us. If you do pay the bill at the time the service is provided, be sure to get a paid receipt. Send a copy of the paid receipt, along with a completed dental reimbursement form, to the address on the back of your ID card. You can submit the dental reimbursement form, or call us and we will mail you the form. You will be reimbursed up to the maximum benefit limit.

 

Always keep a copy of all documents for your records. You must submit your claim to us within 12 months of the date you received the service.

 

Check your Cost Sharing guide for what is covered and how much you will have to pay. Or call Healthplex at 855-973-2803 (TTY: 711). 

Add a 2022 Dental Option to Your Plan

ConnectiCare Choice Plan 2, Choice Plan 3 , and Flex Plan 3 include preventive dental benefits for no additional premium:
  • Member Copay: $0
  • Preventive benefits include:
  • 1 every 6 months: oral exams, cleanings, fluoride, standard x-rays
  • 1 every 36 months: complete series x-ray

With Choice Plan 2, Choice Plan 3, and Flex Plan 3, you have the option to add optional supplemental dental benefits for an additional monthly plan premium. There are three dental plan options.

 

Optional Dental Enrollment Form:

Engish | Spanish 

 

Dental 1 (PPO) Dental 2 (PPO) Indemnity

Monthly premium: $29

Calendar-year benefit maximum: $2,000

Calendar-year deductible: $100

Monthly premium: $39

Calendar-year benefit maximum: $3,000

Calendar-year deductible: $100

Monthly premium: $39

Calendar-year benefit maximum: $3,500

 

Comprehensive Dental Services

  • Member cost-share: 20% after $100 deductible
    • Basic (minor restorative) – Restorations (fillings)
  • Member cost-share: 50% after $100 deductible
    • Major (endodontics, periodontics, and oral surgery)
  • Includes crowns; fixed bridgework; partial and full dentures; re-cement of fixed bridges, inlays; extractions and oral surgery; root canal therapy; implants; and periodontal scaling and planning; periodontal surgery and maintenance.

Indemnity includes preventive and comprehensive dental services

Member Cost-share: 50% of the cost for dental services

 

 

 

 

 

With ConnectiCare Choice Plan 1, Choice Part B Saver, Flex Plan 1, Flex Plan 2, Passage Plan 1 you can add preventive and comprehensive dental benefits for an additional low monthly premium. There are three options.

 

Optional Dental Enrollment Form:

Engish | Spanish 

 

Dental 1 (PPO) Dental 2 (PPO) Indemnity

Monthly premium: $39

Calendar-year benefit maximum: $2,000

Calendar-year deductible: $100

Monthly premium: $49

Calendar-year benefit maximum: $3,000

Calendar-year deductible: $100

Monthly premium: $39

Calendar-year benefit maximum: $3,500

 

Preventive Dental Services

  • Member Copay: $0
  • 1 every 6 months: oral exams, cleanings, fluoride, standard x-rays
  • 1 every 36 months: complete series x-ray

 

Comprehensive Dental Services

  • Member cost-share: 20% after $100 deductible
    • Basic (minor restorative) – Restorations (fillings)
  • Member cost-share: 50% after $100 deductible
    • Major (endodontics, periodontics, and oral surgery)
  • Includes crowns; fixed bridgework; partial and full dentures; re-cement of fixed bridges, inlays; extractions and oral surgery; root canal therapy; implants; and periodontal scaling and planning; periodontal surgery and maintenance.

Indemnity includes preventive and comprehensive dental services

Member Cost-share: 50% of the cost for dental services

 

 

 

 

 

 

 

 

 

 

 

 

we're here to help

Call Us

If not currently enrolled call 877-224-8221
Medicare members call 800-224-2273 
(TTY: 711)

8 a.m. to 8 p.m., seven days a week

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Last Update 10/01/2021

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