The optional supplemental dental benefit can be added to your Senior Blue HMO or Forever Blue Medicare PPO plan. Our dental coverage is an optional supplemental benefit, which means it’s not covered by Original Medicare or included in the benefit package of your plan.
We have two optional supplemental dental benefits to choose from – Basic or Enhanced. Either option gives you the freedom to choose your own dentist because there is no contracted dental provider network. You must continue to pay your Part B premium and your Medicare Advantage plan premium.
|KEY FEATURES AND BENEFITS||Basic Plan||Enhanced Plan|
||$17 per month
||$31 per month|
|Freedom to see any dentist you choose||Yes||Yes|
|Annual maximum allowance for restorative & diagnostic services||$500||$1,000|
|Preventive services (including oral examinations and cleanings/scaling)||50% of the billed cost||Full coverage|
|Diagnostic services (including x-rays, emergency palliative treatment, and lab tests/examinations)||50% of the billed cost||50% of the billed cost|
|Restorative services (including crowns, amalgam and composite resin restorations, endodontic, cementing, and oral surgery)||50% of the billed cost||50% (20% for crowns and cementing/recementing)|
*You must continue to pay your Medicare Part B premium and your Medicare Advantage plan premium.
You must live in one of the following Western New York counties to be eligible for enrollment in one of our Medicare Advantage plans:
Our Star Rating:
This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums and/or copayments/coinsurance may change January 1 of each year. The Formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary. You must continue to pay your Medicare Part B Premium.
Out-of-network/non-contracted providers are under no obligation to treat BlueCross BlueShield of Western New York members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.
Medicare evaluates plans based on a 5-star rating system. Star Ratings are calculated each year and may change from one year to the next.
BlueCross BlueShield of Western New York is a Medicare Advantage plan with a Medicare contract and enrollment depends on contract renewal.
Content Last Updated December 15, 2016