Comprehensive Dental Benefits

Base Dental

 Optional Comprehensive Dental
Providers must be in the Delta Dental Medicare Advantage PPO Network Services can be provided in network through Delta Dental or out of network.*

Available on all plans for $0 premium

Annual maximum coverage amount:

  • $2,000 on BayCarePlus Rewards plan
  • $3,000 on BayCarePlus Complete and BayCarePlus Premier plans

0% coinsurance for covered preventive dental services including oral exams, X-rays and cleanings

0% coinsurance for covered comprehensive dental services including:

  • One periodontal deep cleaning per quadrant every two calendar years
  • Two fillings per calendar year
  • Two root canals per calendar year
  • Two extractions per calendar year

50% coinsurance for covered comprehensive dental services including:

  • Two crowns per calendar year
  • One denture per arch every five calendar years
  • Bridges—one pontic and retainer crown per tooth every five calendar years

Monthly premium:

  • BayCarePlus Rewards: $50.20
  • BayCarePlus Complete and Premier: $49.60

Annual maximum of $4,000 for comprehensive dental

0% coinsurance for covered preventive dental services including oral exams, X-rays and cleanings

0% coinsurance for covered comprehensive services including:

  • One periodontal deep cleaning per quadrant every two calendar years
  • One filling per tooth every two calendar years
  • Two crowns per calendar year
  • Three root canals per calendar year
  • Two extractions per calendar year
  • One denture per arch every five calendar years

 

Base Dental

 Optional Comprehensive Dental
Providers must be in the Delta Dental Medicare Advantage PPO Network Services can be provided in network through Delta Dental or out of network.*

Available on all plans for $0 premium

Annual maximum coverage amount:

  • $2,000 on BayCarePlus Rewards plan
  • $3,000 on BayCarePlus Complete and BayCarePlus Premier plans

0% coinsurance for covered preventive dental services including oral exams, X-rays and cleanings

0% coinsurance for covered comprehensive dental services including:

  • One periodontal deep cleaning per quadrant every two calendar years
  • Two fillings per calendar year
  • Two root canals per calendar year
  • Two extractions per calendar year

50% coinsurance for covered comprehensive dental services including:

  • Two crowns per calendar year
  • One denture per arch every five calendar years
  • Bridges—one pontic and retainer crown per tooth every five calendar years

Monthly premium:

  • BayCarePlus Rewards: $50.20
  • BayCarePlus Complete and Premier: $49.60

Annual maximum of $4,000 for comprehensive dental

0% coinsurance for covered preventive dental services including oral exams, X-rays and cleanings

0% coinsurance for covered comprehensive services including:

  • One periodontal deep cleaning per quadrant every two calendar years
  • One filling per tooth every two calendar years
  • Two crowns per calendar year
  • Three root canals per calendar year
  • Two extractions per calendar year
  • One denture per arch every five calendar years

 

Refer to the Evidence of Coverage for a complete list of services and limits. You may add this benefit when you enroll in a BayCarePlus Medicare Advantage plan. Current members should call (866) 509-5396 (TTY: 711) to add it.

Happy with base dental?

You don’t have to do a thing. You’ll be automatically enrolled in base dental when you enroll in a BayCarePlus Medicare Advantage plan.

Want to upgrade to optional comprehensive dental?

If you’re already enrolled in a BayCarePlus plan, you can add the optional comprehensive dental plan during the Annual Enrollment Period (October 15–December 7) or within 30 days of your initial enrollment date by clicking here or call (866) 509-5396.

If you’re new to BayCarePlus, you can enroll in optional comprehensive dental when you enroll in one of our Medicare Advantage plans.

*The Delta Dental plan will pay benefits for covered services provided by a non-participating provider. However, a non-participating provider may charge you more than the maximum plan allowance payable under this Medicare Advantage plan and you will be responsible for all cost-sharing charges. See the Evidence of Coverage for full details.

Important Disclaimers

For accommodations of persons with special needs at meetings call (877) 549-1741 (TTY: 711).

BayCare Select Health Plans is an HMO plan with a Medicare contract. Enrollment in BayCare Select Health Plans depends on contract renewal. All BayCare Select Health Plans include Part D drug coverage.

To enroll, you must have both Medicare Parts A and B and reside in the plan service area.

You must continue to pay your Medicare Part B premium. Enrollment in a BayCare Select Health Plan may be limited to specific times of the year.

Members must use plan providers except in emergency or urgent care situations. If a member obtains care from an out-of-network provider without prior approval from BayCare Select Health Plans, neither Medicare nor BayCare Select Health Plans will be responsible for the costs.

Information on our utilization management processes, including prior authorization, concurrent review, post service review and appeals, can be found online at Member.BayCarePlus.org.

BayCare Select Health Plans complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.

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MID: H2235_25-077_M_2025 - Last updated: 9/25/2024