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Neighborhood Care

Medicare Dental Coverage

Happy senior couple hugging on a bridge outside

Your Smile Matters

We’re happy to offer quality dental services to many our EmblemHealth VIP Medicare members. Having healthy teeth is part of staying healthy.

2025 Preventive and comprehensive benefits

Our goal at EmblemHealth is to provide you with access to high-quality care, which is why we have contracted with Healthplex to manage the dental needs of our EmblemHealth VIP Medicare members. Healthplex has a large network of participating dentists and specialists.

 

As an EmblemHealth VIP Medicare member, you will pay $0 for preventive services like cleanings, x-rays, exams, and fluoride treatments. For comprehensive dental services, you will pay a $0 to $150 copayment depending on the service. There is no annual dollar limit.

 

Most of our EmblemHealth VIP Medicare Plans include preventive dental services. Plans that include Comprehensive Dental Benefits are EmblemHealth VIP Gold (HMO), EmblemHealth VIP Gold Plus (HMO), EmblemHealth VIP Rx Saver (HMO), EmblemHealth VIP Dual (HMO D-SNP), EmblemHealth VIP Dual Reserve (HMO D-SNP) and EmblemHealth VIP Dual Enhanced (HMO D-SNP).

As a member of EmblemHealth VIP Dual (HMO D-SNP), EmblemHealth VIP Dual Reserve (HMO D-SNP), and EmblemHealth VIP Dual Enhanced (HMO D-SNP), you pay $0 for both preventive and comprehensive dental services.

Get the EmblemHealth Preventive and Comprehensive Dental Brochure

 

2025 Dental Brochure 

Download PDF

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For more information about dental services and participating dentists and specialists, please call EmblemHealth Dental at 855-933-4033, 8 a.m. to 8 p.m., Monday to Friday. If you use a TTY, please call 800-662-1220, 8 a.m. to 8 p.m., Monday to Friday.

2024 Preventive and comprehensive benefits

Our goal at EmblemHealth is to provide you with access to high-quality care, which is why we have contracted with Healthplex to manage the dental needs of our EmblemHealth VIP Medicare members. Healthplex has a large network of participating dentists and specialists.

 

As an EmblemHealth VIP Medicare member, you will pay $0 for preventive services like cleanings, x-rays, exams, and fluoride treatments. For comprehensive dental services, you will pay a $0 to $150 copayment depending on the service. There is no annual dollar limit.

 

Most of our EmblemHealth VIP Medicare Plans include preventive dental services. Plans that include Comprehensive Dental Benefits are EmblemHealth VIP Dual (HMO D-SNP), EmblemHealth VIP Rx Saver (HMO), EmblemHealth VIP Gold (HMO), EmblemHealth VIP Dual Reserve (HMO D-SNP) and EmblemHealth VIP Gold Plus (HMO).

As a member of EmblemHealth VIP Dual (HMO D-SNP) and EmblemHealth VIP Dual Reserve (HMO D-SNP), you pay $0 for both preventive and comprehensive dental services.

Get the EmblemHealth Preventive and Comprehensive Dental Brochure

 

2024 Dental Brochure 

Download PDF

---------------------------

 

For more information about dental services and participating dentists and specialists, please call EmblemHealth Dental at 855-933-4033, 8 a.m. to 8 p.m., Monday to Friday. If you use a TTY, please call 800-662-1220, 8 a.m. to 8 p.m., Monday to Friday.

Covered dental services

Please see the below chart for what you will pay and covered services.

Preventive Dental Benefits

EmblemHealth VIP Dual Reserve (HMO D-SNP) EmblemHealth VIP Dual (HMO-D-SNP), and EmblemHealth VIP Dual Enhanced (HMO-D-SNP)

You Pay:

Other EmblemHealth plans with supplemental dental coverage 

You Pay:
Routine Cleaning/1 every 6 months $0 $0
Fluoride application; Fluoride treatment/1 every 6 months $0 $0
Single Tooth x-rays; Bitewing x-rays/1 every 6 months $0 $0
Periodic Oral Exam; Limited Oral Exam/1 every 6 months $0 $0

Comprehensive Dental Benefits

Restorative

    
Fillings/1 every 24 months $0 $0
Recement Crown (covered after 6 months) $0 $0
Prefabricated Stainless Steel Crowns/1 every 60 months $0 $0
Post and Core in Addition to Crown/ 1 every 60 months $0 $0
Inlay/Onlay and Single Crown Restoration/1 every 60 months $0 $125
Endodontic/Periodontic/Extractions    
Therapeutic Pulpotomy/1 per lifetime $0 $0
Root Canal (molar) Once per permanent tooth per lifetime $0 $20
Root Canal (except molar)/1 per lifetime $0 $0
Gingivectomy/Gingivoplasty per Quadrant/1 every 36 months $0 $20
Osseous surgery – (1-3 teeth) per Quadrant/1 every 60 months $0 $75
Osseous surgery – (4 or more teeth) per Quadrant/1 every 60 months $0 $150
Periodontal Maintenance/1 every 36 months $0 $0
Apicoectomy/Periradicular Services/ 1 per lifetime $0 $20
Scaling and Root Planing/Once every 36 months per quadrant $0 $0
Prosthodontics, Oral/Maxillofacial    
Complete or Partial Denture/1 every 60 months $0 $150
Complete Denture Repair/1 every 12 months $0 $0
Complete Denture Rebase and Reline/1 every 36 months $0 $0
Fixed Partial Denture Pontics, Retainers, Recement/1 every 60 months $0 $150
Extraction or Removal of Tooth – Soft Tissue/1 per lifetime $0 $0
Removal of Bony Impacted Tooth/1 per lifetime $0 $50
Other Surgical Procedures/1 per lifetime $0 $50
Alveoloplasty without Extraction – per Quadrant/1 every 12 months $0 $0
Excision, Incision and Other Repair Procedures $0 $50
Vestibuloplasty – 1 arch per lifetime $0 $50

Other Dental Benefits:

Implants

Orthodontics

Maxillofacial Prosthetics

 $0 Not Covered 

Covered dental services

Please see the below chart for what you will pay and covered services.

Preventive Dental Benefits

EmblemHealth VIP Dual Reserve (HMO D-SNP) and EmblemHealth VIP Dual (HMO-D-SNP)

You Pay:

Other EmblemHealth plans

You Pay:
Routine Cleaning/1 every 6 months $0 $0
Fluoride application; Fluoride treatment/1 every 6 months $0 $0
Single Tooth x-rays; Bitewing x-rays/1 every 6 months $0 $0
Periodic Oral Exam; Limited Oral Exam/1 every 6 months $0 $0
*Comprehensive Dental Benefits    
Fillings/1 every 24 months $0 $0
Recement Crown (covered after 6 months) $0 $0
Prefabricated Stainless Steel Crowns/1 every 60 months $0 $0
Post and Core in Addition to Crown/ 1 every 60 months $0 $0
Inlay/Onlay and Single Crown Restoration/1 every 60 months $0 $125
Endodontic/Periodontic/Extractions    
Therapeutic Pulpotomy/1 per lifetime $0 $0
Root Canal (molar) Once per permanent tooth per lifetime $0 $20
Root Canal (except molar)/1 per lifetime $0 $0
Gingivectomy/Gingivoplasty per Quadrant/1 every 36 months $0 $20
Osseous surgery – (1-3 teeth) per Quadrant/1 every 60 months $0 $75
Osseous surgery – (4 or more teeth) per Quadrant/1 every 60 months $0 $150
Periodontal Maintenance/1 every 36 months $0 $0
Apicoectomy/Periradicular Services/ 1 per lifetime $0 $20
Scaling and Root Planing/Once every 36 months per quadrant $0 $0
Prosthodontics, Oral/Maxillofacial    
Complete or Partial Denture/1 every 60 months $0 $150
Complete Denture Repair/1 every 12 months $0 $0
Complete Denture Rebase and Reline/1 every 36 months $0 $0
Fixed Partial Denture Pontics, Retainers, Recement/1 every 60 months $0 $150
Extraction or Removal of Tooth – Soft Tissue/1 per lifetime $0 $0
Removal of Bony Impacted Tooth/1 per lifetime $0 $50
Other Surgical Procedures/1 per lifetime $0 $50
Alveoloplasty without Extraction – per Quadrant/1 every 12 months $0 $0
Excision, Incision and Other Repair Procedures $0 $50
Vestibuloplasty – 1 arch per lifetime $0 $50

Disclaimers:

Prior authorization is required for some services. Implants are not covered by our plan.

Last Update 10/01/2024

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