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Medicare Offerings |
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Understanding Aetna’s 2019 dental plans
When working with your clients, it’s important you educate them about the dental benefit on any plans they’re considering. There are several different types of dental benefits you may encounter on our plans.
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Different types of dental coverage – Know how each one works
The chart below outlines the three main types of dental coverage offered with our 2019 Medicare Advantage plans (MA/MAPD). While not all plans have a dental benefit (view a list of plans that don’t offer dental), when they do, the dental benefit fits into one of the buckets below.
Embedded Coverage (Network Structure)
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- Included in the plan; members don’t have to enroll separately to get dental coverage.
- With HMO plans, members must use a dental network.
- With PPO plans, members can use out-of-network dentists at higher costs.
- You can find a network dentist online.
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Embedded Allowance (Direct Member Reimbursement Structure)
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- Included in the plan; members don’t have to enroll separately to get dental coverage.
- Requires members to pay upfront and submit a receipt for reimbursement.
- Can be used for preventive and comprehensive services (i.e., all ADA codes, including dentures & implants).
- Members can see any licensed dental provider (no network).
- In certain states (CT, MA, ME, NH and RI), some allowances may have a co-insurance amount. For example, if the co-insurance is 50%, the member is reimbursed for 50% of their costs, up to their benefit maximum.
- Allowance amounts do not rollover each year.
- To request reimbursement:
- Get a receipt or proof of payment from the doctor along with a description of the dental services provided.
- Include the members’ printed name and member ID # on the receipt.
- Submit the receipt to us at the claims address on the ID card (a claim form can be found online at the website on the ID card).
- We’ll reimburse up to the benefit amount.
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Optional supplemental benefit (OSB)
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- Must be purchased separately for an additional premium.
- Members must enroll in an OSB when they enroll in their plan, or within 30 days of plan start date (or during another valid election period).
- Requires member to use a dental network.
- Those with the DMO network need to choose and visit a primary care dentist for us to cover their care.
- PPO members can use out-of-network dentists at higher costs.
- You can find a network dentist online.
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Have questions? We're here to help
Review frequently asked questions about dental coverage here. If you need more help or have other questions, please contact your local Aetna Medicare broker manager. You may also call Aetna Medicare Broker Services at 1-866- 714-9301, Monday through Friday, 8 a.m. to 8 p.m. ET, or email us at brokersupport@aetna.com.
Members can call us at the number on their ID card for help understanding their benefits.
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Prior to engaging in the sale of Aetna or Coventry Medicare products, producers must be ready to sell, which means certified, contracted, licensed in the applicable states, and appointed by Aetna in accordance with state law. As permitted in certain states, Aetna will order appointments after the first sale. This communication is intended for use by brokers only and is not intended for distribution to Medicare beneficiaries. Any publication or distribution of this communication to unauthorized recipients without Aetna’s approval is prohibited.
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