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Understanding Medicare Advantage dental benefit usage and claims

Most Kaiser Permanente Washington individual 2022 Medicare Advantage plans offer your clients various benefits for dental coverage. Benefit usage and claims processes differ depending on the plan and type of dental coverage your client has.

Embedded preventive dental and optional supplemental benefit (OSB) dental plan

Clients on the following Medicare Advantage plans have an embedded preventive dental care benefit that covers preventive dental services at no cost to the member, up to an annual benefit maximum. If your client has one of these plans, they must receive the services from a Delta Dental of Washington participating provider.

  • Centennial
  • Columbia
  • Harbor
  • Key

This information applies whether they have the preventive dental benefit only or the additional comprehensive coverage by having selected the optional supplemental benefit, Delta Dental PPO Plus Premier™ dental plan for the additional $54 per month premium.

Both dental benefits offer your clients access to the same large network of dentists. To find a participating dentist, visit deltadentalwa.com, click “Find a Dentist,” and search under the “Delta Dental PPO Plus Premier” network.

When getting services provided by either of the benefits above, your client should:

  • Provide the dentist with their Kaiser Permanente ID card
  • Let the dentist know that their plan’s dental benefit is administered by Delta Dental of Washington

The dentist will verify the member’s dental benefits with Delta Dental using their Kaiser Permanente member ID number and submit claims to Delta Dental on their behalf. Claims for the preventive dental benefit or the optional supplemental benefit dental plan should not be submitted to Kaiser Permanente by the client or the dentist.

Read more about these dental benefits.

Dental reimbursement allowance

The following Medicare Advantage plans have a dental reimbursement allowance:

  • Basic
  • Essential
  • Optimal

This is a specified amount allowed for any dental service received from any licensed dental provider. To be reimbursed the allowance amount, your client will pay for services and submit their invoice/payment receipt to Kaiser Permanente through the medical claim process.

For details, please visit our claims and appeals page, and see the FAQ on submitting claims for reimbursement. If you have questions, please contact our Medicare Sales Producer Support team, Monday through Friday, at 1-800-581-8252 or KPWA.Medicare@kp.org.

All plans offered and underwritten by Kaiser Foundation Health Plan of Washington or Kaiser Foundation Health Plan of Washington Options, Inc.

© 2021 Kaiser Foundation Health Plan of Washington