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Dental Benefit

Explore your extra dental benefit through Generations Advantage. 

The Martin’s Point Generations Advantage Dental Benefit is administered by Northeast Delta Dental (NEDD). With our dental coverage, there’s no waiting period—so you can start using your benefit as soon as you need it and low or no copays and coinsurance amounts make important preventive care affordable.

For more information, please see your Evidence of Coverage or call Northeast Delta Dental at 1-800-832-5700 (TTY: 1-800-332-5905).

Have questions? We’re here to help.

Talk to a Member Service Representative 8:00AM - 8:00PM, Monday to Friday.

Current Members:
1-866-544-7504 (TTY:711)

Enroll:
1-888-829-6204 (TTY:711)

Explore More Benefits
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IS MY DENTIST IN-NETWORK?

To obtain these supplemental dental benefits at the in-network rates, you must use a Delta Dental network provider in Maine, New Hampshire, or Vermont. 

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I HAVE AN OUT-OF-NETWORK DENTIST

For a higher cost share, Select (LPPO) plan members may also see dentists who accept Medicare outside of this network.

Dental Benefits by Plan

Expand All

Coverage as of 1/1/2023

Member Cost Shares (No Waiting Period)
Amounts under Categories A, B, and C Show What MEMBER Pays

DENTAL BENEFITS BY AREA CALENDAR-YEAR MAXIMUM PAID BY PLAN**  A  DIAGNOSTIC / PREVENTATIVE  B  BASIC RESTORATIVE  C  MAJOR RESTORATIVE

Prime (HMO POS) Counties:

MAINE: Lincoln, Oxford, Piscataquis, Somerset, and Waldo

NEW HAMPSHIRE: Belknap, Carroll, Coos, and Grafton

All services must be received in network.

 $500 per Member No Deductible

$50 Office Visit Copay		 $50 Office Visit Copay and 50% Coinsurance $50 Office Visit Copay and 50% Coinsurance
Calendar Year Deductible per Person: $50

Prime (HMO POS) Counties:

MAINE: Aroostook, Franklin, Hancock, Knox, Penobscot, and Washington

All services must be received in network.

 $750 per Member No Deductible

$50 Office Visit Copay		 $50 Office Visit Copay and 50% Coinsurance $50 Office Visit Copay and 50% Coinsurance
Calendar Year Deductible per Person: $50

Prime (HMO POS) Counties:

MAINE: Androscoggin, Cumberland, Kennebec, Sagadahoc, and York d

NEW HAMPSHIRE: Cheshire, Hillsborough, Merrimack, Rockingham, Strafford, and Sullivan

All services must be received in network.

 $1,000 per Member No Deductible

$50 Office Visit Copay		 $50 Office Visit Copay and 50% Coinsurance $50 Office Visit Copay and 50% Coinsurance
Calendar Year Deductible per Person: $50

Select (LPPO) Counties:

NEW HAMPSHIRE: Belknap, Carroll, and Grafton

$1,000 per Member No Deductible

$50 Office Visit Copay

0% Coinsurance for in-network

50% Coinsurance for out-of-network provider		 Not Covered Not Covered

Alliance (HMO) Counties:

All Maine and New Hampshire Counties.

All services must be received in network.

 $2,500 per Member No Deductible

$0 Office Visit Copay		 No Deductible

20% Coinsurance		 No Deductible

50% Coinsurance

Value Plus (HMO) Counties:

MAINE: Aroostook, Franklin, Hancock, Kennebec, Knox, Lincoln, Oxford, Penobscot, Piscataquis, Sagadahoc, Somerset, Waldo, Washington

All services must be received in network.

 $1,000 per Member No Deductible

$50 Office Visit Copay		 $50 Office Visit Copay and 50% Coinsurance $50 Office Visit Copay and 50% Coinsurance
Calendar Year Deductible per Person: $50

Focus DC (HMO SNP) Counties:

MAINE: Cumberland County

All services must be received in network.

 $1,000 per Member No Deductible

$50 Office Visit Copay
 $50 Office Visit Copay and 50% Coinsurance
 $50 Office Visit Copay and 50% Coinsurance
Calendar Year Deductible per Person: $50
**Expenses incurred by the plan for covered dental services accrue to your annual maximum benefit.

Coverage as of 1/1/2024

Member Cost Shares (No Waiting Period and No Deductible)
Amounts under Categories A, B, and C Show What MEMBER Pays

DENTAL BENEFITS BY AREA CALENDAR-YEAR MAXIMUM PAID BY PLAN**  A  DIAGNOSTIC / PREVENTIVE  B  BASIC RESTORATIVE  C  MAJOR RESTORATIVE
Prime Plan

(Plan ID: H5591-015-001)

MAINE: Lincoln, Oxford, Piscataquis, Somerset, and Waldo Counties

NEW HAMPSHIRE: Belknap, Carroll, Coos, and Grafton Counties

All services must be received in network.

 $500 per Member $50 Office Visit Copay $50 Office Visit Copay and 50% Coinsurance

 $50 Office Visit Copay and 50% Coinsurance
Prime Plan:

(Plan ID: H5591-015-002) 

MAINE: Aroostook, Franklin, Hancock, Knox, Penobscot, and Washington Counties

All services must be received in network.

 $750 per Member $50 Office Visit Copay $50 Office Visit Copay and 50% Coinsurance

 $50 Office Visit Copay and 50% Coinsurance
Prime Plan: 

(Plan IDs: H5591-005, H5591-006-001, H5591-006-002, H5591-006-004, and H5591-006-005)

MAINE: Androscoggin, Cumberland, Kennebec, Sagadahoc, and York Counties

NEW HAMPSHIRE: Cheshire, Hillsborough, Merrimack, Rockingham, Strafford, and Sullivan Counties

All services must be received in network.

 $1,000 per Member $50 Office Visit Copay $50 Office Visit Copay and 50% Coinsurance
 $50 Office Visit Copay and 50% Coinsurance
Select Plan

(Plan ID: H1365-001)

MAINE: All Counties

NEW HAMPSHIRE: Cheshire, Coos, Hillsborough, Merrimack, Rockingham, Strafford, and Sullivan Counties

Not Covered

NOTE: 
Select members pay a $40 Office Visit Copay for Medicare-covered dental services ONLY

Not Covered

 Not Covered Not Covered
Alliance Plan

(Plan ID: H5591-003)

All Maine and New Hampshire Counties.

All services must be received in network.

 $2,500 per Member $0 Office Visit Copay 20% Coinsurance 50% Coinsurance
Value Plus Plan

(Plan IDs: H5591-009 and H5591-013)

MAINE: Aroostook, Franklin, Hancock, Kennebec, Knox, Lincoln, Oxford, Penobscot, Piscataquis, Sagadahoc, Somerset, Waldo, and Washington Counties

All services must be received in network.

 $1,000 per Member $50 Office Visit Copay $50 Office Visit Copay and 50% Coinsurance
 $50 Office Visit Copay and 50% Coinsurance
Access Plan

(Plan ID: H1365-002)

NEW HAMPSHIRE: Belknap, Carroll, Coos, and Grafton Counties

For a higher cost share, Access (LPPO) plan members may also see dentists who accept Medicare outside of this network.

 $1,000 per Member $50 Office Visit Copay
 Not Covered Not Covered
Access Plan

(Plan ID: H1365-003)

NEW HAMPSHIRE: Cheshire, Hillsborough, Merrimack, Rockingham, Strafford, and Sullivan Counties

For a higher cost share, Access (LPPO) plan members may also see dentists who accept Medicare outside of this network.

 $2,000 per Member $50 Office Visit Copay
 $50 Office Visit Copay and 50% Coinsurance
 $50 Office Visit Copay and 50% Coinsurance
**Expenses incurred by the plan for covered dental services accrue to your annual maximum benefit.

Coverage Categories

Below you will find a list of common dental procedures organized by coverage categories.

 A  DIAGNOSTIC/PREVENTIVE  B  BASIC RESTORATIVE  C  MAJOR RESTORATIVE

DIAGNOSTIC:

  • Problem-focused exams as needed
  • X-rays (complete series or panoramic film)
    once in a 5-calendar-year period
  • Bitewing X-rays once in a calendar year
  • X-rays of individual teeth as necessary

PREVENTIVE:

  • Oral exam and routine cleaning*

*NOTE ABOUT CLEANINGS:

2023 Plan Year: Cleanings are limited to one per calendar year for Prime, Focus DC, and Value Plus plan members and two per calendar year for Alliance plan members; you may choose from either a routine cleaning (Coverage A) or a periodontal cleaning (Coverage B). Cleanings are limited to once per calendar year for Select plan members and periodontal maintenance (cleaning) is not a covered benefit.

2024 Plan Year: Cleanings are limited to one per calendar year for Cumberland and York County Prime plan members and two per calendar year for all other members with dental coverage. You may choose from Category A (preventive/routine) and/or Category B (periodontal). Office visit copays and coinsurances apply. Periodontal maintenance (cleaning) is not a covered benefit for Belknap, Carroll, Grafton, and Coos County Access plan members.

RESTORATIVE:

  • Amalgam (silver) fillings†
  • Resin restorations on anterior teeth and
    the buccal surface of bicuspids only

ORAL SURGERY:

  • Surgical and routine extractions

ENDODONTICS:

  • Root canal therapy

PERIODONTICS:

  • Periodontal maintenance (cleaning)*
  • Treatment of gum disease
  • Clinical crown lengthening once per tooth per lifetime

DENTURE REPAIR:

  • Repair of a removable denture to its original condition

EMERGENCY RELIEF OF PAIN:

  • Brush biopsy once in a calendar year

†Additional costs may apply for resin fillings, please reach out to Northeast Delta Dental for more information.

PROSTHODONTICS:

  • Removable and fixed
    partial dentures (bridge);
    complete dentures
  • Rebase and reline (dentures)
  • Crowns
  • Onlays
  • Implants

HAVE QUESTIONS? WE'RE HERE TO HELP.

For more information, please see your plan's Evidence of Coverage. If you'd like to speak with a benefit representative, please call Northeast Delta Dental at 1-800-832-5700 (TTY: 1-800-332-5905).

Evidence of Coverage