Dental, Vision and Hearing Benefits

Dental Benefits

Most of the time dental work isn’t covered by Original Medicare.

We help cover those gaps:

• Annual routine cleanings
• Palliative emergency treatment of dental pain (for HMO plan this must be received by a network provider or not covered)
• Amalgam and composite fillings
• Simple (non-surgical) extractions
• Endodontics (i.e., root canals)
• Major restorative (i.e., crowns and teeth fillings)
• Prosthodontics (i.e., dentures, bridges)
• Prosthetics adjustments and repairs
• Periodontal services (maintenance only)

You have two routine dental visits a year including:

• Cleaning
• Bitewing X-rays (Set of 2)
• Oral Exam
• Fluoride

Our Capital Blue Cross Medicare HMO and PPO benefits cut 30 to 50 percent of the cost for these services depending on your plan (this is not a complete list):

Major Restorative Services:

• Amalgam and composite fillings
• Crowns and crown repairs
• Inlays and onlays, including repairs

Endodontics, Prosthodontics and Extraction Services:

• Simple extractions (non-surgical)
• Dentures
• Repairs, reline and rebase of prosthodontics
• Bridges

Coverage includes a maximum benefit allowance of up to $5000, depending on the Medicare Advantage plan you have. This allowance is combined for preventive and comprehensive non-Medicare-covered dental services.

Important Information:

• Authorizations and referrals are not required for routine dental services. Referrals are not required for comprehensive non-Medicare-covered dental services.
• Coverage for simple extractions (non-surgical extractions) are typically performed by a general dentist. Surgical extractions are typically performed by an oral surgeon are not covered. (Members should confirm whether or not surgical extractions are covered under the Medicare medical plan.)
• Excludes coverage for cosmetic procedures (such as veneers, bleaching, and teeth straightening), dental implants, periodontics, other oral/maxillofacial surgery and any other services not listed as covered.
• Dental implants are not covered
• Crowns on top of an implant are not covered
• PPO benefits reflect in-network coverage
• See your Evidence of Coverage (EOC) for more important information

Pre-Treatment Estimates:

If a member isn’t sure of the benefits for a specific course of treatment, or treatment costs are expected to exceed $300 our plan recommends a pre-treatment estimate. Members should ask the treating provider to submit the claim form in advance of performing the proposed services.

Pre-treatment estimate requests are not required but may be submitted for more complicated and expensive procedures, such as simple extractions, crowns and bridges. The member will receive an estimate of the costs and how much our plan may pay before treatment begins.

For information about your dental benefit, refer to your Capital Blue Cross Medicare PPO Evidence of Coverage or call 866.987.4213 (TYY: 711) or your Capital Blue Cross Medicare HMO Evidence of Coverage or call 800.779.6962 Monday through Friday, 8:00 AM - 8:00 PM. 

Nominate your dentist

Need to file a claim?

Participating providers and some non-participating providers will submit claims for you. You can mail a dental claim form to:

Dental Claims Processing Center
P.O. Box 211424  
Eagan, MN 55121