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Optional Supplemental Dental Coverage
GLO-MDP-Supplemental Dental Coverage - Main Content
Many of our Medicare Advantage Plans already include coverage for preventive dental services. Now you can add more coverage to fit your needs.
How do I enroll?
If you’re new to our Medicare Advantage Plans:
- Indicate on your application that you choose to enroll in Complementary Dental or Full Comprehensive Dental coverage. Enroll Now.
If you’re already an Excellus BCBSUnivera Healthcare Medicare Advantage member:
- Download our dental applicationdental applicationOpen a PDF or ask our Medicare Customer Care AdvocatesMedicare Customer Care Advocates to mail you a dental application.
You can also complete a full enrollment application online. Enroll Now.
What you need to know about enrolling online:
- First select your current Medicare Advantage plan listed on your Excellus BCBSUnivera Healthcare member ID card.
- Once you have selected your plan, you will be prompted to add the associated expanded dental option.
- You will need your Original Medicare number on your red, white and blue card to complete the full online application.
Is my dentist in network?
You can see an out-of-network dentist, but it will cost more.*
What are the costs?
|Complementary Dental||Full Comprehensive Dental|
|Monthly dental premium (In addition to your monthly Medicare Advantage Plan premium and Part B premium.)||$29 a month||$39 a month|
|Preventive dental coverage Up to 2 routine cleanings, 2 oral exams and 2 bitewing x-rays per year|| |
Already covered by your Medicare Advantage Plan.
No additional coverage needed.
In Network: $0 copayment
Out of Network: *The plan will pay up to the maximum allowable benefit for each service covered.
|Annual Deductible**||You pay $100 per calendar year before coverage begins|
|Annual Maximum Benefit**||The plan will pay up to $1,000 per calendar year (services above the limit are your responsibility).|
|Restorative (e.g., restorations, fillings)|| |
In Network: You pay 20% of the cost for each visit
Out of Network: * You pay 50% of the cost for each visit
|Other Services |
Periodontics (e.g., scaling)
Oral Surgery (e.g., extractions)
Endodontics (e.g., root canal)
Prosthodontics (e.g., crowns, dentures, and bridges)
Prosthetic Maintenance (e.g., denture or bridge repairs)
In Network: You pay 50% of the cost for each visit
Out of Network: * You pay 55% of the cost for each visit
Some limits may apply. See the Evidence of Coverage for more information. Expanded dental coverage cannot be added to Medicare Advantage plans received through a former employer.
* The plan will pay up to the maximum allowable benefit for each service covered. If your provider does not participate in our network and charges more than the maximum allowable benefit, you will be responsible for the additional cost.
** The deductible and maximum plan benefit do not apply to preventive services.
This information is not a complete description of benefits. Call 1-800-671-6081 (TDD/TTY 1-800-662-1220) for more information.
Out-of-network/non-contracted providers are under no obligation to treat Excellus BlueCross BlueShieldUnivera Healthcare members, except in emergency situations. 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.
To the extent of any discrepancy between this website and the Evidence of Coverage, the Evidence of Coverage terms take priority.
EXC-MDM-MDP-Supplemental Dental Coverage Dental Application Modal
Modal for Select a Dental Application for your County
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EXC-MDP-Health Plan Scripts
Put stuff here to only use one set of plan pages and NOT create new pages every year
EXC-MDP-Sidebar Enroll button
Monday - Friday:
8 a.m. to 8 p.m.
From Oct. 1 - Dec. 30:
advisors are also available weekends 8 a.m. to 8 p.m.
Closed Thanksgiving Day, Christmas Eve, Christmas Day, New Year’s Eve, and New Year’s Day
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Excellus BlueCross BlueShield contracts with the Federal Government and is an HMO plan and PPO plan with a Medicare contract. Enrollment in Excellus BlueCross BlueShield depends on contract renewal. Submit a complaint about your Medicare plan at www.Medicare.gov or learn about filing a complaint by contacting the Medicare Ombudsman. Y0028_5993.
This page last updated 10-01-2019.