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

We offer HMO and HMO-POS dental benefits, depending on the plan you choose.  HMO dental benefits are available with EmblemHealth VIP Gold and VIP Gold Plus (HMOs); and VIP Dual, VIP Dual Enhanced, and VIP Dual Reserve (HMO D-SNPs). With HMO dental, you must see a network dentist for your services. With HMO-POS plan, like VIP Value, you can see providers outside of our dental network, too.

Both plan types cover preventive services like cleanings, x-rays, exams, and fluoride treatments at $0 cost to you.

For HMO plans’ comprehensive dental services, like crowns, bridges and dentures, you pay $0 to $150 depending on the service. Special Needs  Plan (HMO D-SNP) members pay $0. There is no annual maximum our plan pays towards your dental benefits.

For HMO-POS plan’s comprehensive dental services, you pay 50% of the cost. Our plan will pay the rest up to your annual maximum of $2,000.

EmblemHealth Dental Brochure

Dental Reimbursement Form

List of Covered Dental Services


For more information about dental services and participating dentists and specialists, please call 844-776-8749 (TTY: 711). From Oct. 1 to March 31, you can call us seven days a week from 8 a.m. to 8 p.m. From April 1 to Sept. 30, you can call us Monday through Friday from 8 a.m. to 8 p.m. 

 

Covered Dental Services

Please see the following chart with examples of what is covered and what your share of the cost is. See your Evidence of Coverage for more information.

Preventive Dental Benefits

HMO

HMO D-SNP

HMO-POS

Routine Cleaning/1 every 6 months

$0

$0

$0

Fluoride application; Fluoride treatment/1 every 6 months

$0

$0

$0

Single Tooth x-rays; Bitewing x-rays/1 every 6 months

$0

$0

$0

Periodic Oral Exam; Limited Oral Exam/1 every 6 months

$0

$0

$0

Comprehensive Dental Benefits

Restorative
   
Fillings/1 every 24 months

$0

$0

50%

Recement Crown (covered after 6 months)

$0

$0

50%

Prefabricated Stainless Steel Crowns/1 every 60 months

$0

$0

50%

Post and Core in Addition to Crown/ 1 every 60 months

$0

$0

50%

Inlay/Onlay and Single Crown Restoration/1 every 60 months

$125

$0

50%

Endodontic/Periodontic/Extractions    
Therapeutic Pulpotomy/1 per lifetime

$0

$0

50%

Root Canal (molar) Once per permanent tooth per lifetime

$20

$0

50%

Root Canal (except molar)/1 per lifetime

$0

$0

50%

Gingivectomy/Gingivoplasty per Quadrant/1 every 36 months

$20

$0

50%

Osseous surgery – (1-3 teeth) per Quadrant/1 every 60 months

$75

$0

50%

Osseous surgery – (4 or more teeth) per Quadrant/1 every 60 months

$150

$0

50%

Periodontal Maintenance/1 every 36 months

$0

$0

50%

Apicoectomy/Periradicular Services/ 1 per lifetime

$20

$0

50%

Scaling and Root Planing/Once every 36 months per quadrant

$0

$0

50%

Prosthodontics, Oral/Maxillofacial    
Complete or Partial Denture/1 every 60 months

$150

$0

50%

Complete Denture Repair/1 every 12 months

$0

$0

50%

Complete Denture Rebase and Reline/1 every 36 months

$0

$0

50%

Fixed Partial Denture Pontics, Retainers, Recement/1 every 60 months

$150

$0

50%

Extraction or Removal of Tooth – Soft Tissue/1 per lifetime

$0

$0

50%

Removal of Bony Impacted Tooth/1 per lifetime

$50

$0

50%

Other Surgical Procedures/1 per lifetime

$50

$0

50%

Alveoloplasty without Extraction – per Quadrant/1 every 12 months

$0

$0

50%

Excision, Incision and Other Repair Procedures

$50

$0

50%

Vestibuloplasty – 1 arch per lifetime

$50

$0

50%

Other Dental Benefits:

Implants

Orthodontics

Maxillofacial Prosthetics

Not Covered  Covered  Not Covered