Medicare Dental Coverage | EmblemHealth

Medicare Dental Coverage

Older couple at home.

Your Smile Matters

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

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 Dual Select (HMO D-SNP), EmblemHealth VIP Essential (HMO), EmblemHealth VIP Rx Saver (HMO), EmblemHealth VIP Gold (HMO), EmblemHealth VIP Passport (HMO), EmblemHealth VIP Passport NYC (HMO), EmblemHealth VIP Reserve (HMO) and EmblemHealth VIP Gold Plus (HMO).

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

Get the EmblemHealth Preventive and Comprehensive Dental Brochure

 

2022 Dental Brochure Download PDF English | Español中文

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Optional supplemental benefit for comprehensive dental

EmblemHealth VIP Value (HMO) includes preventive dental benefits and offers an optional supplemental benefit for comprehensive dental benefits. The cost for this optional benefit is $12.50 monthly.

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

* Prior authorization is required for some services.

Disclaimer:

Implants are not covered by our plan. 

Last Update 10/01/2021

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