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Medicare Optional Supplemental Dental HMO and PPO plans in California to smile about.

Medicare for senior

Optional Supplemental Dental HMO and PPO Plans

Having good oral health is important to your overall health. Studies have linked gum disease to increased risks of heart disease, stroke and diabetes.

Our optional supplemental dental HMO plan has a lower premium than our PPO plan, with a monthly premium of $11.60 and offers fixed member out-of-pocket costs. Our HMO plan gives you access to more than 26,500* general dentists statewide.

Our optional supplemental dental PPO plan lets you choose from a larger list of dentists, but you pay a higher premium for this choice - $40.50 for the monthly plan premium. Our PPO plan gives you access to nearly 58,000* general dentists and specialists statewide.

Optional supplemental dental HMO plan highlights

  • A wide range of dental benefits, including many diagnostic and preventive services at no charge to you
  • Fixed copayments for basic and major services
  • No waiting period for all services
  • No deductibles
  • Specialty care available with a referral from your dental provider
  • Virtually no claim forms

Optional supplemental dental PPO plan highlights

  • Unlike the HMO plan, you have access to out-of-network dentists and specialists
  • Specialist care available with NO referral needed from your dentist
  • A wide range of dental benefits, including 100% coverage for in-network diagnostic and preventive services
  • No claim forms if you go to an in-network dentist

Optional supplemental dental HMO and PPO plan benefits at a glance
(Optional dental HMO/PPO benefits comparison)

Benefit
With the optional supplemental
dental HMO plan, you pay*:
With the optional supplemental
dental PPO plan, you pay:
Diagnostic and preventive services -
For your annual dental exam and
six-month checkup.
No deductible
No deductible
• Comprehensive oral exams (D0150)
• Periodic oral exams (D0120)
• Complete X-rays (D0210)
• Adult prophylaxis
(cleanings, every 6 months) (D1110)
$5
$0
$0
$5
 
You pay nothing if you go in-network 
and 20% if you go out-of-network
Minor restorative services 
- Keep your teeth healthy.
No waiting period;
No deductible
No waiting period;
$50 deductible per person
• One-surface composite resin
restoration - anterior (D2330)
• Two-surface composite
resin restoration - anterior (D2331)
$11
 
$17
 
20% if you go in-network and
30% if you go out-of-network
Annual deductible
None
$50 per person not applied to 
diagnostic and preventive services
Annual benefit limit
For specialist services only: $1,000
$1,500 ($1,000 may be used for
services provided by out-of-network
dentists and specialists)


This chart is only a summary. For a complete list of the benefits, exclusions, and limitations, please refer to the Evidence of Coverage.

* All services must be performed, prescribed, or authorized by your network dentist. For the optional supplemental dental HMO only ― If you need to see a specialist, you must get a referral from your dental provider to receive covered specialist services.

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