Blue Shield of California offers two supplemental dental plans to Blue Shield of California Medicare Advantage-Prescription Drug plan members. Members can choose between an Optional Supplemental Dental HMO1 plan and an Optional Supplemental Dental PPO2 plan. These plans offer a wide range of dental benefits, including many diagnostic and preventive services, at no charge to you.
HMO plan
- $11.60 monthly plan premium
- Choose a participating dentist from our large network
- No deductibles
- No waiting period
Why 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 cost—or no cost—to you
- No deductibles or annual benefit limits
- Fixed copayments for basic and major services
- Specialty care provider services available with a referral from your primary dental provider3
- No claim forms
PPO plan
- $40.50 additional monthly plan premium
- See any dentist; you will generally pay less for services when you see a participating dentist
- $50 calendar-year deductible for services beyond diagnostic and preventative services
- No waiting period
Why enroll in an Optional Supplemental Dental PPO plan:
- Choose from over 41,000 general and specialist dentists for maximum coverage. If your dentist is not in our network, you can keep seeing him/her or other non-network dentists, and still get coverage3
- Specialist care available with no referral needed from your dentist3
- A wide range of dental benefits, including 100% coverage for diagnostic and preventive services obtained from a participating dentist
- No waiting periods
- No claim forms if you go to a network dentist
Find a dentist
It’s easy to find a dentist or see if your current dentist is in our network. Use our Find a Doctor tool, and select “Dentists.” Under plan type, choose Blue Shield Inspire Optional Dental Plan (HMO or PPO) or Blue Shield 65 Plus Optional Dental Plan (HMO or PPO).
Find a dentist
Optional Supplemental Dental HMO plans vs Optional Supplemental Dental PPO plans
| Optional Supplemental Dental HMO | Optional Supplemental Dental PPO | |
|---|---|---|
| Monthly Optional Supplemental Dental plan premium | $11.60 | $40.50 |
| Calendar-year deductible (not applicable to diagnostic and preventive services) | None | $50 |
| Calendar-year maximum1 | $1,000 for covered endodontic, periodontic and oral surgery services when performed by an in-network dental specialist. | The maximum amount the plan will pay for covered services and supplies is $1,500 in a calendar year. Up to $1,000 of this maximum amount may be used for covered services and supplies received from non-participating dentists in a calendar year. You pay any amount above the $1,500 benefit maximum in a calendar year. |
| Waiting period for major services | None | None |
| Network access | Participating dentists only | Participating dentists and non-participating dentists |
1All services must be performed, prescribed, or authorized by a participating dentist. If you need to see a specialist and you are enrolled in the Optional Supplemental Dental HMO plan, you must get a referral from your primary dentist to receive covered specialist services. Plan pays a maximum of $1,000 per calendar year for covered specialist services. You are responsible for amounts above $1,000. If you are enrolled in the Optional Supplemental Dental PPO plan, you may go directly to a specialist.
Summary list of services covered with your cost share (amount you pay)
| Service Area Code1 | 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 copay | 50% | 50% |
| Endodontics3: Anterior root canal therapy (D3310) | $195 copay | 50% | 50% |
| Endodontics3: Molar root canal therapy (D3330) | $335 copay | 50% | 50% |
| Periodontics3: Osseous surgery/four or more teeth per quadrant (D4260) | $293 copay | 50% | 50% |
| Periodontics3: Periodontal scaling & root planing/four or more teeth per quadrant (D4341) | $45 copay | 50% | 50% |
| Prosthetics: Complete denture (upper or lower) (D5110 or D5120) | $285 copay | 50% | 50% |
| Prosthetics: Bridge retainer – crown porcelain fused to high noble metal (per unit) (D6750) | $275 copay | 50% | 50% |
| Oral surgery3: Extraction (single erupted tooth) (D7111) | $10 copay | 50% | 50% |
| Oral surgery3: Removal of impacted tooth (complete bony) (D7240) | $80 copay | 50% | 50% |
1ADA codes are procedure codes established by the American Dental Association for efficient processing and reporting of dental claims.
2You pay the copayment plus the cost of precious or semi-precious metals. Porcelain on molar crowns is not a covered benefit.
3For the Optional Supplemental Dental HMO plan, your copayment will be higher if services are performed by a specialist.
Enroll in dental coverage
Current Medicare Advantage-Prescription Drug plan members can sign up using the Optional Supplemental Dental HMO or PPO plan enrollment form (PDF, 186 KB) and send it to us at the address provided on the enrollment form.
If you have any questions about applying for dental coverage, contact your Blue Shield agent. You can also call (877) 890-7587 [TTY: 711] to speak with a Blue Shield of California Customer Care representative. You can call Monday through Friday, 8 am to 5:30 pm, and then October 15 through January 31, you can call Monday through Friday, 8 am to 6 pm.
