For Medicare Supplement plan members, Blue Shield of California offers two different types of Dental PPO plans and Specialty DuoSM1, a dental and vision plan package that provides even more coverage. To find a dental or vision provider near you, use our Find a Doctor tool.
Why do you need a dental or dental and vision plan?
The latest studies show that more than 90% of all common diseases have oral symptoms.2 In addition, eye exams can often detect serious chronic conditions such as diabetes, hypertension, and high cholesterol.3 Luckily, whether you need treatment or just want preventive care, we have options for you. Blue Shield’s optional dental or dental and vision plans provide coverage at a low cost.
Plan F Extra, Plan G Extra, and Plan G Inspire include vision benefits. Those members can add dental coverage with one of our dental PPO plans.
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1. Annual teeth-cleaning benefit is available 1 every 4 months with the Dental PPO 1000, Dental PPO 1500, and Specialty Duo Dental plan for Medicare Supplement plan members.
2. Dental PPO 1500 and Specialty Duo Dental plan for all Medicare Supplement dental plan members have a 12-month waiting period and Dental PPO 1000 dental plan members have a 6-month waiting period for major restorative services and procedures such as crowns, endodontics, periodontics, oral surgery, and removable or fixed prosthetics.
3. If you have the Household Savings Program, you and your other household member need to select and enroll in the same dental PPO plan or dental + vision package in order to receive one bill that combines Medicare Supplement plan with Dental PPO plan or dental + vision package rates.
Dental PPO highlights and summary
| Dental PPO 1000 | Dental PPO 1500 | |
|---|---|---|
| Individual plan monthly rates | $32.10 | $49.80 |
| Calendar-year deductible (per member) | $75/person | $50/person |
| Calendar-year benefit max | $1,000 ($750 may be used for non-network dentists)1 |
$1,500 ($1,000 may be used for non-network dentists)1 |
| Blue Shield pays | ||
| Diagnostic and preventive care (not subject to plan deductibles with network dentists; includes routine oral exams, X-rays, and three teeth cleanings annually) | 100% for network dentists 50% for non-network dentists2 |
100% for network dentists 80% for non-network dentists2 |
| Basic services (includes an oral cancer screening, anesthesia, palliative treatment, and restorative dentistry) | 50% for network and non-network dentists2 | 80% for network dentists 70% for non-network dentists2 |
| Major services3 12-month waiting period for Dental PPO 1500 and 6-month waiting period for Dental PPO 1000 (includes crown buildups, crowns, endodontics, periodontics, oral surgery, prosthetics, inlays, onlays, jackets, post and cores, and veneers) | 50% for network and non-network dentists2 | 50% for network and non-network dentists2 |
1. Each calendar year, the member is responsible for all charges incurred after the plan has paid these amounts for covered dental services.
2. The coinsurance percentage indicated is a percentage of allowed amounts that we pay to providers. Non-network providers can charge more than our allowable amount. When members use non-network providers, they must pay the applicable copayment/coinsurance plus any amount that exceeds our allowable amount. Charges in excess of the allowable amount do not count toward the calendar-year deductible or copayment maximum.
3. Dental PPO 1500 and Specialty Duo Dental plan for all Medicare Supplement dental plan members have a 12-month waiting period and Dental PPO 1000 dental plan members have a 6-month waiting period for major restorative services and procedures such as crowns, endodontics, periodontics, oral surgery, and removable or fixed prosthetics. Medicare Supplement Dental PPO 1000 waiting period for major services is being reduced from 12 months to 6 months.
Specialty Duo dental and vision packages*
Specialty Duo combines the benefits of the Dental PPO 1500 plan with vision care benefits.
With this package, you’ll have the freedom to pick the providers of your choice. Plus you can access some of the largest vision and dental networks in the state. Your costs will be lower when you visit network providers.
| Monthly rates effective July 1, 2020 | Specialty Duo dental and vision package*1 |
|---|---|
| Individual | $55.40 |
Plan F Extra and Plan G Extra already include a vision benefit. If you are interested in dental coverage and are enrolling or enrolled with Plan F Extra and Plan G Extra, please select Dental PPO 1000 or Dental PPO 1500.
Specialty Duo Vision Plan benefits highlights and summary
The following chart is only a summary. For a complete list of the benefits, exclusions, and limitations of the Specialty DuoSM Vision Plan*4, please refer to the Specialty Duo Vision Plan for Medicare Supplement members.
| Service and eyewear | Coverage when provided by network providers | Coverage when provided by out-of-network providers5 |
|---|---|---|
| Comprehensive examination1 - every 12 months | ||
| Comprehensive Exam | 100% | Up to a maximum of $50 |
| Lenses1,2,6 - every 24 months (or 12 months with a prescription change) | ||
| Single vision | 100% after $25 copay | Up to a maximum of $43 |
| Bifocal | 100% after $25 copay | Up to a maximum of $60 |
| Trifocal | 100% after $25 copay | Up to a maximum of $75 |
| Aphakic or lenticular monofocal or multifocal | 100% after $25 copay | Up to a maximum of $104 |
| Frames5 - every 24 months | Up to a maximum of $100 | Up to a maximum of $40 |
| Contact lenses1,5,6 - every 24 months (or 12 months with a prescription change) | ||
| Non-elective (medically necessary)4, hard or soft | Up to a maximum of $500 after $25 copay | Up to a maximum of $200 |
| Elective contact lenses (cosmetic/convenience) | Up to a maximum of $120 after $25 copay | Up to a maximum of $100 |
1. The comprehensive examination benefit does not include contact lens exam services; however the contact lens Allowance may be used towards the fit and evaluation.
2. Each pair of lenses includes a Pinks No.1 and No. 2 tints in the Allowance and up to 60mm in size
3. A prescription change means any of the following: a change in prescription of 0.50 diopter sphere or cylinder or more; a shift in axis of astigmatism of 15 degrees or more; there is a .50 prism diopter change in at least one eye or the new prescription improves visual acuity by at least one line on the standard eye chart.
4. Prior authorization is needed for Non-Elective (medically necessary) contact lenses.
5. Allowance toward the cost in lieu of other eyewear benefits – the difference between the Allowable Amount and the provider’s charge is the responsibility of the Insured, whether dispensed by a Participating Provider or by a Non-Participating Provider.
6. Contacts are in lieu of eyeglass lenses every 12 months.
Become a member today!
You can sign up for a Blue Shield of California dental plan or Specialty Duo dental and vision package on the Medicare Supplement plan application.
Download the following for complete information about these specialty plans:
Specialty Duo Dental plan disclosure
Specialty Duo Vision plan disclosure
Current Medicare Supplement plan members can sign up using the dental plan enrollment application.
For existing Medicare Supplement plan members who want to transfer into Plan F Extra and Plan G Extra, you will need to complete the full application and add your dental plan selection.
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.
Hours:
- Weekdays, excluding holidays: 9:00 a.m. to 4:30 p.m.
Optional Supplemental Dental HMO and Optional Supplemental Dental PPO plans for Medicare Advantage – Prescription Drug plans
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 HMO5 plan and an Optional Supplemental Dental PPO6 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
- No waiting period for most services
- Specialty care provider services available with a referral from your primary dental provider6
- 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 43,000 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 coverage7
- Specialist care available with no referral needed from your dentist7
- A wide range of dental benefits, including 100% coverage for diagnostic and preventive services obtained from a participating dentist
- No 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. Use our Find a Doctor tool, then select “dentist.” 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 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 |
1. All 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% |
1. ADA codes are procedure codes established by the American Dental Association for efficient processing and reporting of dental claims.
2. You pay the copayment plus the cost of precious or semi-precious metals. Porcelain on molar crowns is not a covered benefit.
3. For 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, 172 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.
