Dental services, Medicare

Applies to:

Individual Medicare Advantage plans

Dental services coverage

Non-routine dental services

All individual Priority Health Medicare Advantage plans cover limited non-routine Medicare-covered dental services, such as extraction of teeth to prepare the jaw for radiation treatments.  See the plan's Evidence of Coverage for details.

Routine dental services: coverage offered in 2020

All individual Priority Health Medicare Advantage plans cover some routine dental services with:

  • No waiting period
  • $0 deductible
  • No maximum payment 

PriorityMedicare Edge®PriorityMedicare Ideal® and PriorityMedicare Key®:

  • Cleanings/exams (regular or periodontal maintenance): Two per year covered at 100%
  • Bitewing X-rays: One set (up to 4 films in a single visit) per year covered at 100%
  • Certificate of Coverage (PriorityMedicare Edge, PriorityMedicare Ideal, PriorityMedicare Key)

PriorityMedicare®, PriorityMedicare Merit®, PriorityMedicare Select® and PriorityMedicare Value®:

  • Cleanings/exams (regular or periodontal maintenance): Two per year covered at 100%
  • Bitewing X-rays: One set (up to 4 films in a single visit) per year covered at 100%
  • Brush biopsy: One per year covered at 100%
  • All other radiographs (full mouth series, periapical or panoramic X-rays): One every two years covered at 100%
  • Certificate of Coverage (PriorityMedicare, PriorityMedicare Merit, PriorityMedicare Select, PriorityMedicare Value)

PriorityMedicare® D-SNP

  • Cleanings/exams (regular or periodontal maintenance): Two per year covered at 100%
  • Bitewing X-rays: One set (up to 4 films in a single visit) per year covered at 100%
  • Certificate of coverage (PriorityMedicare D-SNP)

Optional Enhanced Dental and Vision Package

An optional Enhanced Dental and Vision Package is available to members of all individual Medicare Advantage plans, except PriorityMedicare D-SNP.

Coverage runs from Jan. 1 through Dec. 31 of each calendar year, the same as the member's Medicare Advantage plan.

There's no waiting period and no deductible.

To see if the member is enrolled in our enhanced package, check the Member Inquiry tool under supplemental benefits or contact Delta Dental Plan of Michigan Customer Service Department at 800.330.2732, Monday through Friday from 8 a.m. - 8 p.m (Eastern Time). For assistance on Saturday or Sunday, call Priority Health Medicare at 888.389.6648 (TTY users should call 711), from 8 a.m. - 8 p.m.

Enhanced dental package benefits include:

PriorityMedicare Edge, PriorityMedicare Ideal and PriorityMedicare Key:

  • Brush biopsy: One per year covered at 100%
  • All other radiographs (full-mouth series, periapical or panoramic X-rays): One every two years covered at 100%
  • Fillings and crown repair: No limit, covered at 100%
  • Root canals: Once every 24 months per tooth, covered at 50%
  • Emergency treatment of dental pain: No limit, covered at 100%
  • Crowns and associated substructures: Once every 84 months per tooth, covered at 50%
  • Simple extractions (non-surgical removal of teeth): Once per lifetime per tooth, covered at 50%
  • Oral surgery (surgical extractions and other dental surgery): Once per lifetime per tooth, covered at 70%
  • Anesthesia (payable in conjunction with covered services when medically necessary): No limit, covered at 100%
  • Other basic services (certain tests): Once per visit, covered at 50%
  • Relines & repairs to bridges and dentures: Once every 36 months per appliance, covered at 50%
  • Enhanced plan Certificate of Coverage (PriorityMedicare Edge, PriorityMedicare Ideal, PriorityMedicare Key)

PriorityMedicare®, PriorityMedicare Merit®, PriorityMedicare Select® and PriorityMedicare Value®:

  • Fillings and crown repair: No limit, covered at 100%
  • Root canals: Once every 24 months per tooth, covered at 50%
  • Emergency treatment of dental pain: No limit, covered at 100%
  • Crowns and associated substructures: Once every 84 months per tooth, covered at 50%
  • Simple extractions (non-surgical removal of teeth): Once per lifetime per tooth, covered at 50%
  • Oral surgery (surgical extractions and other dental surgery): Once per lifetime per tooth, covered at 70%
  • Anesthesia (payable in conjunction with covered services when medically necessary): No limit, covered at 100%
  • Other basic services (certain tests): Once per visit, covered at 50%
  • Relines & repairs to bridges and dentures: Once every 36 months per appliance, covered at 50%
  • Enhanced plan Certificate of Coverage (PriorityMedicare, PriorityMedicare Merit, PriorityMedicare Select, PriorityMedicare Value)

Not covered:

  • Composite resin (white) restorations on posterior teeth; Priority Health will pay only the amount it would have paid for an amalgam restoration
  • Implants
  • Relines and repairs to spare dentures

Annual limit

Enhanced dental benefits cover up to $1,500 in claims per year. 

Participating Delta Dental provider billing

A participating provider is a dentist located in Michigan, Indiana or Ohio who is part of the Delta Dental Medicare Advantage PPO and/or Medicare Advantage Premier network for all Priority Health Medicare Advantage plans, except PriorityMedicare D-SNP which uses Delta Dental Medicare Advantage PPO providers only. All other dentists are considered out-of-network (non-participating) providers.

Participating dentists agree not to charge patients more than the maximum approved fee for a covered service.

Submit claims directly to Delta Dental for payment within one year of the date the services were completed.

Delta Dental has 30 days from the date of receiving a claim to determine payment or notify you if they need additional information. The notice will:

  • Describe and explain why the additional information is needed
  • Request an extension of time in which to determine the claim
  • Inform you that the information must be received within 45 days or your claim will be denied.

If you do not supply the requested information, Delta Dental will deny the claim.

Once Delta Dental receives the requested information, it has 15 days to make a final decision on the claim, and 5 days after the decision to notify you.

Delta Dental of Michigan will send payment directly to participating dentists.

The member is responsible for incurred charges after plan allowances as outlined in the member certificate.

Non-Delta Dental provider billing

If you are a non-participating dentist (defined as a dentist who is NOT part of the Delta DentalMedicare Advantage PPO or Medicare Advantage Premier network in Michigan, Indiana or Ohio for all plans), you will be paid the non-participating dentist's fee for covered services. If you charge more for a service than the rate Delta Dental has agreed to pay, the member will be responsible for paying the difference.

You must participate with Medicare to be reimbursed.

Submit claims directly to Delta Dental for payment. The process for determining claims is the same as for participating providers, above.

Delta Dental usually sends payments to the member, and then the member is responsible for making full payment to the dentist. The member is responsible for any difference between the Delta Dental payment and the amount the dentist submitted.

Send to:

Delta Dental
P.O. Box 9298
Farmington Hills, MI 48333-9298

Join a Delta Dental Medicare Advantage Plan network

We encourage all providers to contract with Delta Dental Plan of Michigan so the member will receive the best rates for their dental services. Sign an agreement with the Delta Dental Plan of Michigan to participate in the Delta Dental Medicare Advantage PPO network and/or Delta Dental Medicare Advantage Premier network. 

Go to deltadentalmi.com to join the network.