Enhanced Dental Coverage through the Delta Dental Network!
You're covered for a wide variety of preventive and comprehensive dental services! And, we've increased our annual maximum on our Garnet (HMO) and Ruby (HMO) plans. Supplemental dental coverage can be purchased for an additional $37 monthly premium.
Preventive and Comprehensive Dental Coverage
Included with all plans
Through our partnership with Delta Dental of Ohio, this coverage includes access to the Delta Dental Medicare Advantage PPO Network (Garnet members also have access to the Delta Dental Premier Network) and features the following benefits:
- $0 office visit copay, includes:
- Two cleanings
- Two exams
- One fluoride treatment
- One bitewing x-ray per year
- Full mouth or panoramic x-rays once every five years
- Periapical x-rays as needed
- Emergency treatment of dental pain as needed
- Fillings, simple extractions, and root canals:
- $0 copay for fillings, simple extractions, and root canals with the Amber (HMO), Topaz (HMO), Jade (HMO) and Garnet (HMO) plans
- 50% coinsurance for fillings, simple extractions, and root canals with the Ruby (HMO), Sapphire (HMO-POS) and Emerald (HMO-POS) plans
- Bridges, crowns and dentures:
- 20% for bridges, crowns, crown repairs and dentures with the Topaz and Jade plans
- 40% for bridges, crowns, crown repairs and dentures with the Garnet plan
- 50% for bridges, crowns, crown repairs and dentures with the Amber plan
- 70% for bridges, crowns, crown repairs and dentures with the Ruby, Sapphire and Emerald plans
Included with some plans
- Periodontal maintenance, non-surgical periodontics and relines and repairs to bridges and dentures:
- $0 copay with the Garnet plan. Not covered on other plans unless Optional Supplemental Dental is purchased.
Annual dental maximum amounts for 2025:
- $3,000 -- Topaz, Jade
- $2,500 -- Garnet
- $2,000 -- Amber, Ruby, Sapphire, Emerald
Optional Supplemental Dental Coverage
If you elect to enroll in our optional supplemental dental plan, you’ll pay an additional $37 per month in order to obtain the following additional benefits. You must keep paying your Medicare Part B premium and your SummaCare Medicare plan premium. The following benefits are in addition to the embedded benefits covered in your plan.
The following optional supplemental benefits are in addition to the embedded dental benefits included in your plan and have a 50% coinsurance.
- Inlays and onlays
- Relines and Repairs to bridges and dentures*
- Periodontal Maintenance
- Periodontal Non-Surgical* & Surgical Procedures
- Surgical Extractions
- Oral Surgery
- Anesthesia
- Occlusal guards and adjustments
- Brush biopsy
*Covered under the embedded benefit for the Garnet plan.
Things to note:
- If you purchase the optional supplemental dental benefit, the plan will pay a total maximum for your preventive and supplemental benefits of $2,000 for Amber, Ruby, Sapphire and Emerald; $2,500 for Garnet; $3,000 for Topaz and Jade.
- If you purchase the optional supplemental dental benefit, Ruby, Sapphire and Emerald will have a lower cost share for bridges, crowns, crown repairs and dentures (50% on optional supplemental vs. 70% on embedded).
- Services must be received through the Delta Dental Medicare Advantage PPO and Medicare Advantage Premier Networks.
- Services received from dentists who do NOT participate in the Delta Dental Medicare Advantage PPO and Medicare Advantage Premier Networks are NOT covered benefits.
- Covered services under the optional supplemental dental plan will be equal or greater to those covered under the embedded plan.
