Healthier smile, healthier you

Did you know that the majority of common diseases have oral symptoms?1 Studies have shown that periodontal (gum) disease is linked to serious diseases such as heart disease, stroke, osteoporosis, and diabetes2. When some diseases are diagnosed early, treatment can be more successful and, in turn, reduce your overall cost of health care.

Blue Shield offers two supplemental dental plans to Blue Shield 65 Plus (HMO), Blue Shield 65 Plus Choice Plan (HMO) and Blue Shield Trio Medicare (HMO) members. Members can choose between an optional supplemental Dental HMO3 plan and an optional supplemental Dental PPO plan. These plans offer a wide range of dental benefits, including many diagnostic and preventive services at no charge to you.

HMO plan

  • $12.40 additional monthly plan premium
  • Access to large network of dentists, and you must choose a participating dentist
  • No deductibles
  • No waiting period

PPO plan

  • $34.90 additional monthly plan premium
  • See any dentist; you will generally be charged less for services if you use a participating dentist.
  • $50.00 calendar-year deductible for services beyond diagnostic and preventative services
  • No waiting period for preventative services
  • Six-month waiting period for major services

 

Good reasons to enroll in the optional supplemental dental HMO plan

  • Many annual routine and diagnostic care services, such as teeth cleaning and X-rays, are available at a low or no cost to you.
  • No deductibles or annual benefit limits.
  • Fixed copayments for basic and major services.
  • No waiting period for most services.
  • Specialty care provider services are available with a referral from your primary dental provider.4
  • Virtually no claim forms.

Good reasons to enroll in the optional supplemental dental PPO plan

  • Choose from any of the over 52,889 general and specialist dentists For maximum coverage. If your own dentist is not in-network, you can keep seeing him/her, or other non-network dentists, and still get coverage.4
  • Specialist care available with NO referral needed from your dentist.4
  • A wide range of dental benefits, including 100% coverage for diagnostic and preventive services obtained from a participating dentist.
  • Only a 6 month waiting period for major services.
  • No claim forms if you go to a network dentist.
  • Coverage for three cleanings every year.

 

Find a dentist

It’s easy to find a dentist or see if your current dentist is in our network. Choose dentist, and when asked if you have a plan in mind, choose the applicable Blue Shield 65 Plus Optional Dental Plan Network (HMO or PPO).

 

Optional supplemental dental HMO plans vs Optional supplemental dental PPO

 
Optional supplemental dental HMO
Optional supplemental dental PPO
Monthly optional supplemental dental plan  premium
$12.40
$34.90
Calendar-year deductible (not applied to diagnostic and preventive services)
None
$50
Calendar-year maximum5
$1,000 for covered endodontic, periodontic and oral surgery services when performed by an in-network dental specialist.
$1,500 for covered preventive and comprehensive dental services combined, no matter if the services are performed by a participating general dentist or a dental specialist in a calendar year. Up to $1,000 of this maximum amount may be used for covered preventive and comprehensive dental services performed by non-participating dentist in a calendar year. You pay any amount above the calendar-year benefit maximum.
Waiting period for major services
None
6 months
Network access
Participating dentists only
Participating dentists and non-participating dentists

Summary list of services covered with your cost share (amount you pay)

Service (ADA code)6
You pay with Dental HMO plan
You pay with Dental PPO plan
  Participating providers Participating providers Non-participating providers
Diagnostic services: Comprehensive oral evaluation (D0150)
$5 copay
(2 visits in 12 months)
0%
(2 visits in 12 months)
20%
(2 visits in 12 months)
Diagnostic services: Full mouth X-rays (D0210)
$0 copay
(1 series every 24 months)
0%
(1 series every 36 months)
20%
(1 series every 36 months)
Preventive care: Prophylaxis – adult (cleanings) (D1110)
$5 copay
(one cleaning every 6 months)
0%
(one cleaning every 4 months)
20%
(one cleaning every 4 months)
Restorative services: One surface composite resin restoration – anterior (D2330)
$11 copay
20%
30%
Restorative services: Crown (porcelain fused to noble metal) (D2750)
$275 copay7
50%
50%
Endodontics8: Anterior root canal therapy (D3310)
$195 copay
50%
50%
Endodontics8: Molar root canal therapy (D3330)
$335 copay
50%
50%
Periodontics8: Osseous surgery/four or more teeth per quadrant (D4260)
$293 copay
50%
50%
Periodontics8: Periodontal scaling & root planing/four or more teeth per quadrant (D4341)
$45 copay
50%
50%
Prosthetics: Bridge pontic/false tooth – porcelain fused to high noble metal (per unit) (D6240)
$210 copay7
50%
50%
Prosthetics: Bridge retainer – crown porcelain fused to high noble metal (per unit) (D6750)
$275 copay7
50%
50%
Prosthetics: Complete denture (upper or lower) (D5110 or D5120)
$285 copay
50%
50%
Oral surgery8: Extraction (single erupted tooth) (D7111)
$10 copay
50%
50%
Oral surgery8: Removal of impacted tooth (complete bony) (D7240)
$80 copay
50%
50%