Medicare Medicare

2016 Optional Supplemental Dental Benefit

The optional supplemental dental benefit can be added to your SelectSaver HMO-POS plan. Our dental coverage is an optional supplemental benefit, which means it’s not covered by Original Medicare or included in the benefit package of your plan. We have two optional supplemental dental benefits to choose from – basic or enhanced. With the basic plan, you pay $17 per month. With the enhanced plan you pay $31 per month. Either option gives you the freedom to choose your own dentist because there is no contracted dental provider network. You must continue to pay your Part B premium and your Medicare Advantage plan premium.


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Additional Information

Key Features and Benefits Basic Plan Enhanced Plan
2016 Monthly Premium* $17 $31
Freedom to see any dentist you choose Yes Yes
Annual maximum allowance for restorative & diagnostic services $500 $1,000
Preventive services (including oral examinations and cleanings/scaling) 50% of the billed cost 100% of the billed cost
Diagnostic services (including x-rays, emergency palliative treatment, and lab tests/examinations) 50% of the billed cost 50% of the billed cost
Restorative services (including amalgam and composite resin restorations, endodontic, cementing, and oral surgery) 50% of the billed cost 50% (20% for crowns and cementing/recementing)


*You must continue to pay your Medicare Part B premium and your Medicare Advantage plan premium.

 

 

 

How to Enroll

Download a  paper application complete it and return to us.




When to Enroll

2016 Annual Enrollment Period (AEP): Medicare Advantage members can enroll in the optional supplemental DENTAL benefit during the 2016 AEP which begins on October 15 and ends on December 7. Once the AEP ends, the optional supplemental DENTAL benefit will not be available until the next AEP. Your dental coverage will be effective on January 1, 2016.


Initial Election Coverage – 
Members new to Medicare can purchase the optional supplemental DENTAL benefit during their initial election coverage period (ICEP).

The ICEP is the period during which an individual newly eligible for Medicare may make an initial enrollment request to enroll in a Medicare Advantage plan.

Your dental coverage will be effective on the first day of your enrollment into your Medicare Advantage plan.

 

 

 

This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums and/or copayments/coinsurance may change January 1 of each year.  The Formulary, pharmacy network, and/or provider network may change at any time.  You will receive notice when necessary. You must continue to pay your Medicare Part B Premium.

 

Medicare evaluates plans based on a 5-star rating system. Star Ratings are calculated each year and may change from one year to the next.

 

HealthNow New York Inc.  is a Medicare Advantage and stand-alone PDP plan with a Medicare contract. Enrollment in HealthNow New York Inc. depends on contract renewal. 

 

Y0086_MRK1600 Approved 

Content Last Updated January 19, 2016

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