Dental benefits

Oral health is an important part of overall well-being, which is why we offer two high-value dental options for you to purchase along with your medical plan. A healthy smile can help ensure a healthier life and minimize your healthcare costs.

2017 optional supplemental dental benefits

For members of Providence Medicare Advantage Plans

  Basic Option  Enhanced Option 
Monthly Premium  $33.70 $48.20
Plan Benefits In-network member responsibility Out-of-network member responsibility* In-network member responsibility Out-of-network member responsibility*
Office visit copay No copay No copay
Annual deductible1
$50  $150 $50 $150 
Annual maximum $1,000 $1,500
Waiting periods None None
Provider network Any licensed dentist2 Any licensed dentist2
Out-of-network reimbursement Maximum allowable charge Maximum allowable charge
Diagnostic & Preventive Services
Oral examinations3 0% 20%
0%
20%
Semi-annual teeth cleaning4 0%
20%
0%
20%
Bitewing x-rays5 0%
20%
0%
20%
Full, panoramic and other diagnostic x-rays6 0%
20%
0%
20%
Comprehensive Dental Services
Basic fillings & simple extractions 50% 60% 50% 60%
Dentures7 50%
60%
50%
60%
Crowns and bridges8,9 50%
60%
50%
60%
Oral surgery Not covered 50%
60%
Endodontics (root canals) Not covered
50%
60%
Periodontics Not covered
50%
60%
Prosthodontics, other oral/maxillofacial surgery Not covered
50%
60%

*Important note: Out-of-network dentists may charge more than the amount allowed by Providence Medicare Advantage Plans. If this happens, they may "balance bill" you for the difference between the charged amount and the amount paid by the Plan.

1Deductibles are waived for diagnostic and preventive services
2Seeking care from a participating in-network dentist will reduce out-of-pocket costs and prevent a balance bill
3Oral examinations – limited to two per calendar year
4Teeth cleanings (Prophylaxis – cleaning, scaling and polishing teeth) - limited to two per calendar year
5Bitewing X-rays – limited to two per calendar year
6Full, panoramic or other diagnostic X-rays – limited to one per five years
7$250 lifetime denture benefit
8Crown/bridge max (Basic) – $100 per tooth per year
9Crown/bridge max (Enhanced) – $500 per year


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 on January 1 of each year. The provider network may change at any time. You will receive notice when necessary. You must continue to pay your Medicare Part B premium.