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Decision: unknown

The rules say that plans must pay for a medical service or item if regular Medicare would pay for it in this case. 
You can find this rule at 42 Code of Federal Regulations (CFR) Section 422.101. 
 
The rules say that Medicare will not pay for dental services. Dental services are items and services involving 
the care, treatment, filling, removal or replacement of teeth or structures directly supporting the teeth. Medicare 
defines "structures directly supporting the teeth" as the periodontium, which includes the gingivae, 
dentogingival junction, periodontal membrane, cementum of the teeth, and alveolar process. You can find this 
rule in the Social Security Act, Section 1862(a)(12) and in the Centers for Medicare and Medicaid Services, 
Internet Only Manual, Publication 100-02, Medicare Benefit Policy Manual, Chapter 15, Section 150. 
 
The rules state that items and services furnished outside the United States are excluded from coverage except 
for the following services, and certain services rendered on board a ship: 
 
- Emergency inpatient hospital services where the emergency occurred:  
          - While the beneficiary was physically present in the United States; or  
          - In Canada while the beneficiary was traveling without reasonable delay and by the most direct route 
between Alaska and another State. 
- Emergency or nonemergency inpatient hospital services furnished by a hospital located outside the United 
States, if the hospital was closer to, or substantially more accessible from, the beneficiary's United States 
residence than the nearest participating United States hospital which was adequately equipped to deal with and 
available to provide treatment of the illness or injury;  
- Physician and ambulance services furnished in connection with a covered foreign hospitalization. Program 
payment may not be made for any other Part B medical and other health services, including outpatient services 
furnished outside the United States;  
- Services rendered on board a ship in a United States port, or within 6 hours of when the ship arrived at, or 
departed from, a United States port, are considered to have been furnished in United States territorial waters. 
Services not furnished in a United States port, or within 6 hours of when the ship arrived at, or departed from, a 
United States port, are considered to have been furnished outside United States territorial waters, even if the 
ship is of United States registry; and  
- The term "United States" means the 50 States, the District of Columbia, the Commonwealth of Puerto Rico, 
the Virgin Islands, Guam, the Northern Mariana Islands, American Samoa and, for purposes of services 
rendered on a ship, includes the territorial waters adjoining the land areas of the United States. 
 
You can find these rules in the Medicare Benefit Policy Manual Chapter 16, Section 60. 
 
If you want to read these Medicare rules, you can go to this website www.medicareappeal.com. 
 
The Plan contract says that the Plan covers items and services in accordance with Medicare rules. The contract 
says that the Plan covers certain dental services as a supplemental (extra) benefit. The Plan contract says that 
you may see any licensed dental provider who accepts Medicare patients in the United States and has not opted 
out of Original Medicare. You can find this information on page 62 of the Plan's 2020 Evidence of Coverage.