2017 Optional Supplemental Dental Benefit

 

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.

 

  • For more details, read the 2017 Benefits at a Glance

  • Add the Optional Supplemental Dental Benefit to your plan by enrolling in membership.
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KEY FEATURES AND BENEFITS Basic Plan Enhanced Plan
2017 Premium*
$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:

  • Allegany
  • Genesee
  • Cattaraugus
  • Niagara
  • Chautauqua
  • Orleans
  • Erie
  • Wyoming

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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.

Y0086_MRK1717 Approved
Content Last Updated December 15, 2016

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