Aetna | compliance connection For Aetna Medicare Distribution Partners

December 1, 2023

Note: This edition revises the newsletter sent earlier today. We’ve clarified below that the second paragraph applies to both PPO plans and HMO Point-of-Service plans.

Aetna Medicare dental offerings give your clients plenty to smile about Here’s how to make that smile last throughout 2024

In this issue, we’ll take you through the Who, What, and Why of Aetna Medicare dental to help you avoid client confusion and complaints to CMS.

WHO can your clients see to obtain dental care?

It depends on the type of dental package they have, as detailed below.

Plans with a network-based dental package

For HMO medical plans with a network-based dental benefit, your client must use a dental provider that is part of the dental network. Most plans use the Aetna Dental Preferred Provider Organization (PPO) network. However, those in California, Florida, and Nevada use the Liberty Dental network.

For PPO medical plans and HMO Point-of-Service (POS) medical plans that have a network-based dental benefit, your client can use a dentist outside the network, but in some plans, they will have a greater cost-share. Both PPO and HMO-POS medical plans use the Aetna Dental PPO network.

TIP #1: Check the type of medical plan that your client has, since this drives their network dental benefit. HMO plans always require members to use a network dental provider. PPO and HMO-POS plans allow members to use out-of-network dental providers.

TIP #2:  Check if your client’s dentist is in the network.

Plans with the Aetna dental direct member reimbursement (DMR) package

Clients can see any licensed dentist but they may need to pay out-of-pocket and then seek reimbursement.

TIP #3: For clients with a dental DMR benefit, make sure they understand how reimbursement works.

WHAT dental services does Aetna offer?

Aetna offers dental coverage in all its 2024 Medicare Advantage with Prescription Drug (MAPD) plans and many different dental packages. Each package covers one or more of the services below. Most packages provide coverage up to an allowance/maximum amount each year.

Preventive services Covered by all dental packages and offered by all plans; includes oral exams, cleanings, and bite-wing x-rays.

Basic comprehensive servicesOffered in most packages; includes fillings, routine extractions, and other services.

Major comprehensive services – Offered in most packages. Includes but is not limited to molar root canals, crowns, and dentures. Some packages cover implants. Check the Evidence of Coverage for details.

TIP #4: Always check to see if the dental benefit has an annual dental allowance and what services are covered. For example, your client’s plan may pay up to $2,000 annually for covered preventive and comprehensive services combined. Other plans may include preventive services outside this annual maximum.

WHY are dental benefits important to your clients?

Original Medicare only pays for some specific dental services that are closely related to other covered medical services, such as surgery to treat jaw fractures. Aetna Medicare plans provide coverage for additional services your client may need. Dental services are expensive, but your clients’ oral health is a vital part of their overall physical and mental health.

  • Untreated gum disease has been linked to cardiovascular disease and rheumatoid arthritis.
  • Tooth loss can seriously impact your client’s ability to speak, socialize, and eat.
    • As an example, Jane loved having breakfast every Sunday with her friends, but since she lost her front tooth she’s embarrassed and has stopped going out. She’s feeling increasingly isolated and lonely. If Jane can find a plan to cover her needed dental work, she’ll be ready to socialize again.
For more information, contact a Pinnacle Financial Services representative today

1 (800) 772-6881 x7731 | sales@pfsinsurance.com

Contact a Pinnacle Representative if you have any questions.

1 (800) 772-6881


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