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Benefits

With our dental coverage, you have 100 percent coverage on routine exams, cleanings and other preventive services, as well as 50 percent coverage on restorative care, prosthetics and other dental services.

View the Evidence of Coverage

How to enroll

If you're enrolling in the Freedom plan for the first time, select dental coverage when you enroll. You can enroll for medical, prescription drug and dental coverage using the same form.

If you are a current Freedom plan member, you can add dental coverage during the Annual Enrollment Period from October 15 through December 31, 2013. To enroll, please fill out this form and then mail or fax it to Medicare Sales.


Benefit

Coverage

Monthly Premium $39.33

Preventive and Diagnostic Care

  • Routine examinations and cleanings
  • Other preventive services
100% Coverage

Sealants

  • Pit and fissure sealants
50% Coverage

Regular and Restorative Care

  • Fillings
  • Oral surgery
  • Periodontics (gum treatment)
  • Endodontics (root canal therapy)
50% Coverage

Special Restorative Care

  • Restorative crowns
  • Onlays
50% Coverage

Prosthetics

  • Bridges
  • Dentures
  • Partial Dentures
50% Coverage
Annual Deductible $50 per calendar year for regular and restorative care, special restorative care and prosthetics.
Annual Maximum

$1,100 per calendar year. $200 may be applied to out-of-network services.

Preventive and diagnostic services do not apply to the annual maximum for Freedom Balance and Freedom Ultimate.

Preventive and diagnostic services do apply to the annual maximum for Freedom Vital.


The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan. Limitations, copayments, and restrictions may apply. Benefits, formulary, pharmacy network, provider network, premiums and/or copayments may change on January 1 of each year. You must continue to pay your Medicare Part B premium.